Inspection on 17/11/09 for Reuben Manor

This inspection was carried out on 17th November 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Reuben Manor 16/09/09

Similar services:

Turret Villa Retirement Home

Moor House

Mendip House

Beaconsfield Court Care Home

Little Sisters Of The Poor

Manor House

Middleton Hall Ltd

Middlesbrough Intermediate Care Centre

Extracts from inspection reports are licensed from CQC, this page was updated on 18/02/2010.

Key inspection report Care homes for older people Name: Address: Reuben Manor 654 Yarm Road Eaglescliffe Stockton on Tees TS16 0DP     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Jacqueline Herring     Date: 1 7 1 1 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 35 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 35 Information about the care home Name of care home: Address: Reuben Manor 654 Yarm Road Eaglescliffe Stockton on Tees TS16 0DP Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Julie Peyton Type of registration: Number of places registered: care home 83 Silk Healthcare Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category sensory impairment Additional conditions: The maximum number of service users who may be accommodated is 83 The registered person may provide the following category of care service only: Care home with nursing- Code N. To service users of the following gender: Either whose primary care needs on admission are within the following categories: Old age not falling within any other category : Code OP 83. Dementia Code DE 83 Date of last inspection Brief description of the care home Reuben Manor is a purpose built; three storey 83 bedded care home providing both nursing and personal care. The home has seperate units, called suites for the four different categories of care. All bedrooms are single rooms. There is a good amount of communal space on all three of the floors as well as very pleasant gardens. The home Care Homes for Older People Page 4 of 35 58 0 0 Over 65 0 30 0 Brief description of the care home is situated at Eaglescliffe, in close proximitiy to public transport and other public amenities. Care Homes for Older People Page 5 of 35 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is one star. This means the people who use this service experience adequate quality outcomes. This Key Inspection was to check that the home meets the standards that the Commission for Social Care Inspection say are the most important for the people who use the services, and that it does what the Care Standards regulations say it must. This inspection was conducted by one inspector, one local area manager and a pharmacy inspector in one inspection day. This Key Inspection was carried out within six months of the service being registered. During the inspection, a number of records were looked at, including records of people who use the service, along with staff recruitment and training records. The medication systems was also looked at and discussed at length. Care Homes for Older People Page 6 of 35 Discussions also took place with people living at Reuben Manor as well as a number of staff, visitors, manager and operations/new business manager. An Annual Quality Assurance Assessment (AQAA), the services self-assessment of how well they think they are meeting standards had also been completed prior to the last Key Inspection. Information was also used from it for this inspection. A number of surveys were also completed and returned to us from people living at Reuben Manor, their relatives, visiting professionals and staff. We have reviewed our practice when making requirement to improve national consistency. In future if a requirement is repeated it is likely that enforcement action will be taken. Discussion took place with the manager and newly appointed Operation/New Business Manager. There was productive discussion about the service and ongoing development of the management systems. Care Homes for Older People Page 7 of 35 What the care home does well: What has improved since the last inspection? What they could do better: A number of areas have been identified that will improve and enhance the service and care already in place at Reuben Manor. Care Homes for Older People Page 8 of 35 The Statement of Purpose and Service Users Guide need some slight amendment as does the complaints procedure. The care needs assessments, risk assessments and care plan also need to be reviewed to ensure that they capture the information needed in terms of meeting peoples needs. These records should be written so that they are accessible to all staff who are involved in meeting peoples care needs. A number of improvements are needed in relation to the medication systems to ensure that people receive the medication they need and that they systems are safe. The issues around visiting at mealtimes need to be corresponded to people living at Reuben Manor, their relatives and staff. The way in which people can express more individual choice about the meal preferences should also be explored. Staff need to received formal induction at a very early stage in their employment and all staff need to receive Protection of Vulnerable Adults training and all of the mandatory training to ensure health, safety and wellbeing. A good recording system should be implemented to detail all of this training. Staff need to understand issues that are reportable to the local safeguarding unit. The staffing levels should remain under review to ensure that they are sufficient to meet the needs of people living at Reuben Manor. The qualified nurses need to have the skill, knowledge and experience to meet the different categories of nursing care and there needs to be evidence to support this. The quality assurance systems should continue to be developed to ensure that the service is being operated in the best interests of people living there. All staff are to receive formal supervision on a regular basis. Staff need to understand the range of circumstances that need to be notified to CQC. Individual outlets to which people have access to hot water need to be tested and recorded. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 35 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 35 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with the information they need in respect of Reuben Manor. People have their needs assessed prior to being admitted to the home and are assured that there needs can be met. Evidence: The Statement of Purpose and Service Users Guide were both looked at. They in the main contained all of the information needed, however it was agreed with the manager and Operations/New Business Manager that there was the need to update some of the information, such as staff list and information about complaints. Currently the complaint procedure signposts people to CQC if not satisfied with how the complaint has been handled by the organisation. There was the need to add the local authorities contact details as well as details of the local ombudsman. Three sets of care records were looked at, one for the most recent person admitted to the residential unit, one for a person with complex general nursing needs and one for Care Homes for Older People Page 11 of 35 Evidence: a person with complex dementia care needs. In all care records looked at, there was evidence of a good pre admission assessment along with evidence of care management information and also reviews. It was confirmed that the pre admission assessments are carried out prior to people being admitted to Reuben Manor and are completed by a member of senior staff, who has the necessary qualification and knowledge. Care Homes for Older People Page 12 of 35 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have their needs assessed and generally appropriate plans are in place to show how they are to be cared for or supported, however further information is needed which will enhance these records further. The medication system needs to be strengthened further with additional measures which will further protect people using the service. Evidence: Three sets of peoples care records were looked at in detail. It is clear that a lot of work and time has been spent on developing peoples care records. Whilst the assessment and risk assessment documentation are comprehensive in format, there is the need to be mindful of more personal, individual needs, as the assessments were primarily of a tick box or numerical nature and it was identified that further information was needed in order to determine the level or type of need so that care could be planned properly. There is also the need to ensure that information contained within the risk assessments is cross referenced with assessment and care plan information. For Care Homes for Older People Page 13 of 35 Evidence: example one risk assessment states that the person should be weighed weekly but they are only being weighed monthly. Another risk assessment identifies that a person is at increased risk of infections but there is no care plan in place for this. A range of care plans have been developed which were individual, with some really good information about peoples preferences. The care plans were discussed in detail as a number of the care plans were of a multi care plan nature, incorporating several care needs. In others, the actual care need was not clear and additional interventions were needed. An example of this included a person who was not compliant with their medication. The monthly evaluations of the planned care are taking place, there is the need to ensure that these evaluations contain a good level of information about the effectiveness or not of the care and support provided. The daily statements of care contained a good level of detail and were informative. It was also identified that challenging behaviour incidents had occurred between people living at Reuben Manor, however no incident report had been completed and no follow up action taken as a result. There is the need to ensure that this type of behaviour is individually assessed, that appropriate risk assessments are in place along with risk management strategies and that in the event that this type of incident occurs that appropriate reporting takes place, key professionals informed and there is active follow up. There was also information about GP, district nurses and other health professionals involvement contained within the care records. Discussion took place with the manager and Operations/New Business Manager about the care records. They had already identified that there was work to do with them both in terms of content as well as developing a more accessible format as currently they are somewhat cumbersome. People spoken to felt that they were being well cared for. One person said, Everyone is very kind and do their job well, the girls are very kind . A survey completed by a relative had the following comment in respect of what the service does well, Offers personalised care of a high standard . A member of staff said of what the service does well, It is a lovely atmosphere and they are entertained all day. Care is top class. Care Homes for Older People Page 14 of 35 Evidence: A relative said, Staff are lovely, really kind, it is a lovely place, lovely atmosphere and very welcoming. Staff also gave good examples about how they meet the privacy and dignity needs of people living at Reuben Manor and this was observed throughout the inspection process. One relative spoken to said, I feel my wife is being well cared for, I have no worries, if I did I would speak to the nurse. The medication systems were looked at by a pharmacy inspector. There was a good set of medicine policies which if followed help staff work consistently and reduce the risk of medication errors. It was found that medication storage varied between units. Medicines were stored in a locked trolley within a locked room and spare medication was locked in cupboards. A record of room temperature was not kept in all units and in some areas the room temperature was recorded as above twenty five degrees centigrade. The date of opening was not always added to eye drops, liquids and medicines with a limited use once open. This means that the medication may be used beyond the expiry date recommended by the manufacturer and make them unsafe to administer. There is a signature sheet available for staff signing MAR charts. A current photograph was attached to the MAR chart and allergies were recorded. This helps reduce medication being given to the wrong person. There were very few gaps on the MAR charts however the code O for other was used on a number of occasions. There was no definition on the chart to explain why the person had not received their medication. There is inconsistency in the recording of the quantity of medication supplied and the date received. The quantity of medication from one monthly cycle to another is not accurately recorded on the new MAR chart. This means that it is difficult to have a complete record of medication within the home and to check if medication is being administered correctly. There was medication in one trolley that was no longer prescribed or on the MAR chart. Medication that has been stopped must be removed from the trolley and disposed of to prevent incorrect administration. Where there is handwritten entries for medicines or dose changes complete records should be made including where possible a witness signature and a record of the person authorising the change. This makes sure there is an accurate record of any changes or new medicines. Care Homes for Older People Page 15 of 35 Evidence: Some MAR charts detailed medication not given because there was no stock available. It is important to make sure that the quantity of medication is regularly checked so that a prescription can be ordered in plenty of time to prevent people being without. Creams were stored in residents bathroom and bedrooms. None had a date of opening. Some were unlabeled and others had been dispensed by the pharmacy for a person other than the person using them. MAR chart records were incomplete for these. Some risk assessments for medication were missing from care plans however the records kept in the MAR folder for people on anticoagulation medicines were good and included result, dose, and date of next test. Controlled drugs were stored in locked cupboards which appears to meet regulations, stock balanced with the records. Care Homes for Older People Page 16 of 35 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People generally have choice and control over their lives. People have many opportunities to be involved in social and recreational activities. The home provides a varied and balanced diet for people who use the service. Evidence: The AQAA detailed that there was a range of social and recreational activities for people. People spoken to said activities available includes, pottery, giant snakes and ladders, arts and crafts, DVD quiz games, WII fit, cinema afternoon with ice-cream trolley. There is a dedicated activities co-ordinator who was spoken to during the random inspection of the service and who was clearly very enthusiastic about their role. On the day of the key inspection activities were taking place in the different units, with sing-along and sherry in one unit and giant snakes a ladders in another unit. Staff spoken to confirmed that whilst there was an activities programme, each unit will also do their own activities. Without exception very positive comments were received about the activities both Care Homes for Older People Page 17 of 35 Evidence: through talking to people living at the home, relatives and staff and through the completed surveys. One person said, The activities programme and entertainment provided are well thought out and enjoyed by most participants. Lots of activities/outings etc - committed to keeping residents active/stimulated. Lots of activities for residents, and little treats. Care records looked at contained information about peoples lives and interests. These were discussed with the manager and Operation Manager about increasing the amount of information and making specific comments about lifestyle and interests as currently the social assessment is a tick box form. The manager agreed and said that they would add some additional information. People spoken to thought there was enough going on in terms of recreational activities on a day to day basis. They also confirmed that they were able to make decisions about their daily lives and that they were shown respect by the staff. The menu was looked at, which was currently a three week rotational menu. This menu clearly detailed choice and variety. The menu is however under review and people are being consulted about it. From observation that took place in the ground floor dining room, there was evidence of choice with different people having different meals. The dining room is a very pleasant environment and the tables were appropriately set with linen table cloths and napkins along with condiments. Again, people spoke very positively about the meals, they said, Food is good , Food is nice, Food is excellent, good variety on the menu. Whilst there was choice available on the menu, how people are offered choice needs to be explored further, particular for those people who are not fully able to express themselves. Currently, in some of the units quantities of both main meals are sent up, however in the event that all people wanted the same meal, there would not be sufficient quantities. There was additional discussion about mealtimes, as for a period of time there had been an introduction of protected mealtimes, whereby visitor were requested not to visit at these times unless agreement had been given by the service. We were informed that protected mealtimes were not in operation within the home at the time of the key inspection, however staff, visitors and people living at the home all said that people were not able to visit at mealtimes. It was agreed the the service would formally write to people to inform them that protected mealtimes were no longer in operation. Care Homes for Older People Page 18 of 35 Evidence: It was confirmed that arrangement had been made for a representative from a nearby church to visit. Other arrangements would be made depending upon the needs of individual people living at the home. Care Homes for Older People Page 19 of 35 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the home are confident their complaints would be acted upon, although people have not always followed the correct procedure. There is the need for the information about complaints to be updated and the procedure further shared with all people involved in the service. People who live at the home are not fully protected from abuse by the homes policies and procedures. Evidence: The AQAA detailed that there had been no complaints since time of registration. CQC and the local contracting and commissioning unit had however received a number of complaints about the service. It was identified that the manager had not always been made fully aware of concerns raised, as such these had not been recorded. The actual complaints procedure needs to be reviewed and updated as it currently signposts people to CQC if they are not satisfied with the way in which the service has managed their complaint and CQC do not investigate complaints. There is the need to include the contact details for the funding bodies for those people being supported with funding for their care and also for the local ombudsmen. Staff who had worked at the home for some time confirmed that they had completed some Protection of Vulnerable Adults training as part of their induction, however not all staff employed had completed this. Care Homes for Older People Page 20 of 35 Evidence: It was also identified that there were some incidents which were potentially of a safeguarding nature, these involve challenging behaviour incidents between people living at Reuben Manor. Discussion took place about the need to be mindful of this type of incident and that they may result in a referral to the local safeguarding unit. A relative who had completed a survey said, I had concerns that I wasnt getting enough information, I addressed this with the staff and communication instantly improved and has been maintained. This is an excellent reflection on the positive attitude of the home. Care Homes for Older People Page 21 of 35 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Reuben Manor provides people with an extremely well decorated, furnished, homely and spacious environment in which to live. Evidence: Reuben Manor is a beautiful 83 bedded purpose built care home. It provide a range of care services to people within four individual units called Suites. It is a spacious home, which is beautifully decorated, with very good quality furnishings, ornaments and pictures and very nicely appointed bedrooms for people, which are all ensuite. There is significant communal space and feature areas such as the piano lounge as well as the Cafe area which has become a hub for people living in the home as well as visitors. One relative said, The coffee bar is wonderful. The ground floor provide people with personal care. On the first floor, there are two Suites, one providing general nursing care and the one Suite providing EMI residential care. As with the ground floor there is a good amount of lounge area, dining areas, and room for people to walk around with a seperate room for activities and reminiscence. There are lovely gardens both to the front and rear of the home. Gardens are accessible to people living at the home. The rear garden has garden furniture and raised beds. Water features are also in place in both gardens. Care Homes for Older People Page 22 of 35 Evidence: A number of comments were made about the environment both through talking to people and through the completed surveys. Comments included, It is a beautiful environment. One of the major assets is the provision of a tea/coffee lounge for residents and families to use, this provides a friendly welcoming meeting point for all. Staff spoken to confirmed there was sufficient equipment such as moving and handling hoists to meet the needs of the people they are caring for along with equipment to manager infection control. Care Homes for Older People Page 23 of 35 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are protected by the way the home recruits staff and their needs are generally met by the staff, however induction training and other training does not fully ensure safety and wellbeing of people living at Reuben Manor. Evidence: Six sets of staff files were looked at, three of which the most recently employed staff. The records looked at showed that all of the checks needed, such as references and Criminal Bureau checks had been completed prior to commencement of employment. For those staff who had been employed some time there was evidence of induction training, covering a range of mandatory training such as moving and handling, fire safety and infection control and supporting of certificates were in place on their files. For those staff who had been employed more recently, there was no evidence of induction or training. The manager described a process of orientation and staff did confirm that they shadowed a more experience staff member for a number of days. Staff spoken to who had commenced employment more recently confirmed that they did not complete a formal induction. Whilst there was a training matrix in place, it was unclear how up to date the staff team were with regard to their mandatory training and training necessary for their job Care Homes for Older People Page 24 of 35 Evidence: role. It was however confirmed that these records were being developed and there would be an up to date system on the computer. We were also informed that a company trainer was also being employed. A range of training material had recently been purchased in the form of DVDs, which will form part of the mandatory training for staff within Reuben Manor. During discussion with staff, they also said that they would benefit from additional training such as catheter training for qualified nurses. People living at the home generally thought there was sufficient staff available to meet their needs. A number of completed surveys by relatives and staff indicated that there was not always sufficient staff on duty and more concern was expressed about this in relation to the EMI nursing unit. Comments included, Insufficient staffing, use of agency staff which impacts upon continuity of care. Employ more staff in the EMI Nursing Unit due to the needs of the residents. They also thought that having some gender mix within the staff team would be beneficial to the people living in this unit. Staff spoken to also said that the use of agency staff can be difficult, again in relation to continuity of care. A member of staff made the following comment in one of the surveys, Problems with staffing, which has settled down of late. Too many residents came in at once before the staff had settled down and established themselves. It took a while for the staff to catch up. A further comment made by a relative included, There is a core of staff who are excellent, they work well as a team and are well trained. A person living at Reuben Manor said, The staff are very approachable and helpful. The staff seem to know all the residents very well. A relative made the following comment in a survey, The staff are caring and friendly, the dignity of the residents is respected at all times (and they have fun!). I have been hugely impressed. The duty rota was made available, it was however a little difficult to interpet and it was not clear that there were additional staff on duty providing one to one cover. Discussion took place with the manager and operations manager regarding the skill mix of qualified nurses as there is not always an RMN on duty during the day and there is no RMN cover for night duty. There is the need to ensure that where cover is being provided from a nurse with a different qualification, that they have the required knowledge, skill and experience to provide nursing care for the different categories of care. The night duty qualified nursing cover is being completed by an RGN working Care Homes for Older People Page 25 of 35 Evidence: across the two floors. It was confirmed that recruitment is continuing and that it is planned that there will be RGN and RMN cover 24 hours per day. The percentage of care staff with a minimum of NVQ II needs to be confirmed. Care Homes for Older People Page 26 of 35 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whilst people are very happy at Reuben Manor, there is the need for the continued development of more effective management systems, which will ensure the welfare and wellbeing of people living at the home. Evidence: The manager is registered with CQC and has the qualifications and experience to undertake this role and has a proven track record as a registered manager of care home management. Staff spoken to said if they had any concerns they were able to speak to the manager about them and that the manager is approachable. One member of staff said, If any member of staff had any problems the manager is always there to help in any way she can. Information discussed previously in this report and cross referenced to the management and organisation outcome group has showed that a number of the Care Homes for Older People Page 27 of 35 Evidence: management and quality assurance systems within the service need to be further developed and embedded within the service. Discussion took place regarding the management structure and role definition within Silk Healthcare. An Operation/New Business manager has recently been appointed and will now be working with the registered manager in further developing Reuben Manor, their quality assurance systems and other management systems to ensure effective and sound management of the service. People spoken to thought that in the main, Reuben Manor was well run. They described the manager as being supportive and approachable. Of what the service does well, a number of very positive comments were made, these included comments from visiting professionals who said, Welcoming and friendly atmosphere, Clean environment, helpful staff and always know about individual patients. People living at Reuben Manor and their relatives said, I enjoy being here and met some lovely friends and Im glad your all here for us. Activities well thought out. All staff welcoming and ready to go the extra mile. Personal allowances were looked at, the records showed two signatures and that the sample looked at balanced correctly. The quality assurance system is being further developed, as is appropriate for a new service. There was brief discussion about the systems to be introduced. A number of staff spoken to said that they had not as yet had supervisions or an appraisal. The main maintenance and servicing certificates were not looked at as this is a recently registered home and at the time of registration all the appropriate certification was in place and in order. A sample of in house maintenance and servicing records were looked at, this included the weekly fire alarms test and testing and recording of water temperatures. The weekly fire test is being carried out appropriately and records in place supported this. The records detailing the testing of water temperatures however did not contain the detail required, for example, it detailed ground floor - ok. There is the need to detail the temperature of each outlet to which people living at the home have access and where there is body submersion, there is the need to test and monitor these facilities Care Homes for Older People Page 28 of 35 Evidence: on a weekly basis as specified by the Health and Safety Executive. The policies and procedures were not looked at during this inspection due to the service being newly registered and was an area looked at during the registration process. It was however identified through looking at the other outcome areas that there is the need to review some of the policies and procedures, this included complaints, management of untoward incidents and also ensuring that staff have the knowledge to know what is reportable under regulation 37 of the care home regulations 2000. Within the area of health and safety it was also identified that further detail in needed in respect of accident analysis. Accident analysis also needed to be developed further, with the analysis being completed regularly. Care Homes for Older People Page 29 of 35 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 30 of 35 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 Medication must be stored securely and safely and at temperatures recommended by the manufacturer. A system must be in place to check expiry dates and to add a date of opening when necessary. This makes sure medication is safe to administer. 31/12/2009 2 9 12 All medication is 31/12/2009 administered as prescribed and available to administer from. Accurate records must be kept for all medicines including creams. This will make sure that people receive their medications correctly and the treatment of their medical condition is not affected. Care Homes for Older People Page 31 of 35 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 3 18 18 All staff must receive Protection of Vulnerable Adults training. This will ensure that the safety, wellbeing and welfare needs of people living at the home are protected. 31/12/2009 4 30 18 Staff must receive appropriate induction training on commencement of employment. This will ensure they have the appropriate training for the work they are to and ensure the health, safety and wellbeing of people living at the home. 08/01/2010 5 37 37 Notifications that affect peoples welfare, wellbeing and safety must be forwarded to CQC. This will ensure that appropriate action has been taken and people are protected. 31/12/2009 6 38 13 The records detailing the testing of water temperatures must be more specific and contain detail of the specific areas tested. This particularly relates to baths and showers where 31/12/2009 Care Homes for Older People Page 32 of 35 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action there is full body submersion. This will help to ensure the health and safety of people using these facilities. 7 38 13 All staff must receive induction and ongoing mandatory training. This will ensure they have the knowledge needed to keep the people they are caring for, staff and themselves safe and protected. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 31/12/2009 1 1 The Statement of Purpose and Service Users Guide should be reviewed and updated in respect of the staff list and the complaints information. The evaluation of care should be a valued based judgement about the effectiveness or not of the care provided. Care plans should be reviewed to ensure they are specific to the care needs identified and clearly give the staff the information they need to meet peoples care needs. The care needs assessments should be developed further to include more specific information about individual needs. Risk assessment should contain more information and where risks are identified, appropriate risk management strategies, or plans of care should be in place to show how these risks are being managed. 2 3 7 7 4 5 7 8 Care Homes for Older People Page 33 of 35 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 6 9 Codes used to record why medicine administration has not taken place must be clearly defined so detailed information on a persons medical treatment can be obtained. Handwritten entries and changes to MAR charts should be accurately recorded and detailed. This makes sure that the correct information is recorded so a person receives their medication as prescribed. A system should be in place to record all medication received into the home and medication carried over from the previous month. This helps confirm that medication is being given as prescribed and when checking stock levels. The current review of the menu should be completed along with ensuring systems are in place to allow for people to have a full choice of the meals on offer. As agreed, any restrictions on the times for which people are able to visit should be lifted and relatives should be formally written to so that they are clear that they are now able to visit at mealtimes. The complaints procedure should be reviewed and updated and should clearly outline the process to be followed and people to contact. The qualified nurses experience, skill, qualification and additional training should be fully recorded and should show that they have the necessary knowledge and skill to meet the needs of the different categories of nursing care. The staffing of the home should remain under review to ensure that the staffing levels of staff are appropriate to meet the needs of the people living at Reuben Manor. The systems under development to ensure that the service is being operated in the best interests of people living at Reuben Manor should be fully implemented. All staff should receive formal supervision at least 6 times per year. 7 9 8 9 9 15 10 15 11 16 12 27 13 27 14 33 15 36 Care Homes for Older People Page 34 of 35 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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