Inspection on 24/06/08 for Revelstoke Lodge

This inspection was carried out on 24th June 2008.

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

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

Other inspections for this house

Revelstoke Lodge 16/06/09

Revelstoke Lodge 22/06/07

Revelstoke Lodge 17/05/06

Revelstoke Lodge 17/02/06

Revelstoke Lodge 02/12/05

Revelstoke Lodge 05/07/05

Revelstoke Lodge 01/12/04

Revelstoke Lodge 16/06/04

Revelstoke Lodge 24/02/04

Similar services:

The Vicarage

Fairfields Country Rest Home

7 Hyde Road

5 Seafield Road

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE Revelstoke Lodge Boringdon Road Plympton Plymouth Devon PL7 4DZ Lead Inspector Jane Gurnell Key Unannounced Inspection 24th June 2008 09:45 X10029.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 Revelstoke Lodge DS0000003603.V367248.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 and Care Homes for Adults 18 – 65*. 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. Revelstoke Lodge DS0000003603.V367248.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Revelstoke Lodge Address Boringdon Road Plympton Plymouth Devon PL7 4DZ 01752 343001 01752 345575 revelstoke@schealthcare.co.uk 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) Ashbourne Homes Ltd Vacancy Care Home 65 Category(ies) of Old age, not falling within any other category registration, with number (55), Physical disability (20), Physical disability of places over 65 years of age (12) Revelstoke Lodge DS0000003603.V367248.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following categories: Physical disability - Code PD 2. Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is 65. 22nd June 2007 Date of last inspection Brief Description of the Service: Revelstoke Lodge is registered to accommodate a maximum of 65 service users. The home provides care for up to 55 service users of either gender over the age of 65 years requiring nursing or personal care with physical illness, disability or frailness and a maximum of 20 service users aged 18-65 years with physical disability. Accommodation is provided on two floors, there is level access both internally and externally via ramps and a passenger lift. Bedrooms are mainly single though several doubles are available. Some bedrooms offer the added benefit of en-suite facilities. The communal rooms offer space for dining and recreation. A lounge room is provided for people living in the home who wish to smoke. The home is owned by Southern Cross Healthcare which operates a large number of care homes nationally. The current fees range from £300 to £900 dependent upon support needs. All people living in the home are issued with a contract breaking down the fees so people can see who is paying what. The service user guide and last inspection report is on display in the entrance foyer. Revelstoke Lodge DS0000003603.V367248.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is one (1) stars. This means the people who use this service experience adequate quality outcomes. This unannounced inspection was undertaken over two days, Tuesday 24th June from 09:45am until 4:30pm and Wednesday 25th June from 09:30am to 12:30pm. The Acting Manager, in post since May 2008 and the newly appointed Manager, in post since 23rd June, were present throughout. This inspection report also includes information from a random inspection undertaken on the 21st of May as a result of concerns raised through social services with regard to the quality of the nursing care in the home. A tour of the home was carried out and each person living in the home was spoken with. Not everyone was able to express their views about the quality of the support they received and due to this the Commission had sent to surveys for them and their relatives to complete prior to the inspection. Six visiting relatives were spoken, the majority of who were satisfied with the care and support provided at Revelstoke Lodge. The majority of staff on duty over two days were spoken with and documents relating to the care of five people living in the home were examined in detail. Other documents relating to the management of the home were also examined, such as staff personnel files, training and supervision records and matters relating to health and safety including maintenance of the fire alarm system. What the service does well: Revelstoke Lodge is homely, comfortable and clean. The staff were described by people living in the home and their relatives as “wonderful” and very kind and caring. One family describe the staff as part of their extended family and another said that their relative’s health had improved significantly since moving to the home. Regular training for the staff helps to assure staff have the knowledge and skills to care for differing health care needs as well as maintain the health and safety of people living in the home. People are able to maintain contact with family and friends and visitors were welcome at all reasonable times of the day. Revelstoke Lodge DS0000003603.V367248.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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. The summary of this inspection report can be made available in other formats on request. Revelstoke Lodge DS0000003603.V367248.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Outcomes Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6, 9, 16 and 18–21) (Standards 7, 15 and 17) (Standards 22–23) (Standards 24–30) (Standards 31–35) (Standards 8, 10 and 37–43) Revelstoke Lodge DS0000003603.V367248.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. (YA NMS 1) Each service user has a written contract/ statement of terms and conditions with the home. Each Service User has an individual contract or statement of terms and conditions with the home. (YA NMS 5) No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Prospective Service Users’ individual aspirations and needs are assessed. (YA NMS 2) Service users and their representatives know that the home they enter will meet their needs. Prospective Service Users know that the home they choose will meet their needs and aspirations. (YA NMS 3) Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Prospective service users have an opportunity to “test drive” the home. (YA NMS 4) Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 4 and 5. Quality in this outcome area is good. People living in the home or are considering moving to Revelstoke Lodge have good information about the home in order to make an informed decision about whether the service is right for them. The personalised needs assessment means that people’s diverse needs are generally identified and planned for before they move to the home. The home is not registered to provide intermediate care, but do provide respite care for a variety of people. This judgement has been made using available evidence including a visit to this service. Revelstoke Lodge DS0000003603.V367248.R01.S.doc Version 5.2 Page 9 EVIDENCE: The home offers accommodation in two specific units, one for older people on the first floor and one for younger adults on the ground floor. The home offers respite care to families. Since concerns were raised in May 08 about the quality of the nursing care there have been no new admissions to Revelstoke Lodge. However, it was evident in the care plans examined that pre-admission assessments had been undertaken. The newly appointed Manager was aware of the home’s admission procedure and confirmed she would visit the person considering moving to the home to undertake an assessment of their care needs and provide them with details about the home. Before a decision is made visits to the home are encouraged to meet the staff and other people living in the home, and several people spoken with confirmed this. The Service User Guide detailing the services provided at Revelstoke Lodge and the last inspection report were displayed in the entrance foyer along with information about local services, upcoming events and the complaints procedure. Revelstoke Lodge DS0000003603.V367248.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6, 9, 16, 18 –21 (Adults 18-65) are: 7. The service user’s health, personal and social care needs are set out in an individual plan of care. Service Users know their assessed and changing needs and personal goals are reflected in their individual plan. (YA NMS 6) Also Service Users are supported to take risks as part of an independent lifestyle. (YA NMS 9) Service users’ health care needs are fully met. Service Users physical and emotional health needs are met. (YA NMS 19) 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, retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicine. (YA NMS 20) Service users feel they are treated with respect and their right to privacy is upheld. Service Users rights are respected and responsibilities recognised in their daily lives. (YA NMS 16) Also Service Users receive personal support in the way they prefer and require. (YA NMS 18) Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The ageing, illness and death of a Service User are handled with respect and as the individual would wish. (YA NMS 21) 8. 9. 10. 11. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 9, 16, 18, 19 and 20 (Adults 18-65) are the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 and 11. Quality in this outcome area is adequate. Improvements in communication between Nurses and care staff, care planning and the daily reviewing of people’s care needs have improved practice, however, long-term medical conditions are not being reviewed sufficiently to manage these safely. Medication practices are safe. This judgement has been made using available evidence including a visit to this service. Revelstoke Lodge DS0000003603.V367248.R01.S.doc Version 5.2 Page 11 EVIDENCE: At the inspection in May 2008 the care plans were found to be insufficiently detailed to ensure people’s needs were clearly identified. The care plans had not been reviewed for several months prior to April 2008 and where risks to health had been identified, such as developing pressure sores or through poor nutrition, the care plans did not provide information regarding how these risks were to be reduced. Also, the recording of nutritional intake was inadequate and it was not possible to assess of the quality and amount of food taken by people. This was of particular concern for people who were diabetic as it was not possible to identify whether they were receiving enough to eat in the evenings to prevent their blood sugar from being very low in the mornings. Insufficient attention was paid to monitoring the diet and fluid intake of those people who required assistance by staff. As a result the home failed in its duty to protect 2 people from harm caused by their deteriorating health. Four people were moved to other care homes as it was felt their welfare could not be guaranteed. Following the inspection in May, a Senior Manager from Southern Cross Healthcare was placed at Revelstoke Lodge as the Acting Manager: the home had been without a Manager since February 2008. He has worked closely with people living in the home, their families and the staff team to identify an action plan to address the requirements made at the inspection with regard to the nursing care within the home. The action plan was made available to the Commission in May and was reviewed at the time of this inspection in June: all the actions identified had been met. Also two Senior Nurses from care homes within the organisation also came to Revelstoke Lodge to work with the Nurses to review the care planning and health care needs of those people living in the home. Those care plans examined were found to contain more detail with regards to people’s health care needs and any associated risks, as well as the action necessary by staff to meet these needs. Nutritional intake was better recorded and it was noted that one person’s blood sugar levels were much more stable than they had been at the inspection in May. However, another person’s blood sugar levels were found to be high and she said this was a cause for concern to her and her family. The Nurse from Plymouth City’s Review Team, who has been working in the home to support the nursing staff, had identified these concerns prior to this inspection and no action had been taken by the home to address this. When we spoke to the Nurse on duty about the blood sugar levels she was unable to identify why these were consistently high. The daily care notes stated that although this person had been seen by her GP on several occasions her blood sugar levels were only discussed in February. Revelstoke Lodge DS0000003603.V367248.R01.S.doc Version 5.2 Page 12 One person’s care plan did not contain the information detailed in his daily notes file held in his bedroom with regard to daily physiotherapy exercise and when this was drawn to the attention of the Nurse on duty it was added on the 2nd day of the inspection. Other health care professionals have also been working closely with the staff team to address the shortfalls identified in May including, Plymouth City Council’s Review Team; Tissue Viability Nurses, one employed by the organisation and one employed by Primary Care Trust; Continence Management Nurse; Speech and Language Therapist to offer advise for people with swallowing difficulties; a Psychologist; a Learning Disability Nurse and a Dietician. Five Nurses have attended Tissue Viability Training since the inspection in May to ensure they have the skills to recognise someone at risk from skin breakdown, the actions required to reduce this risk and, should a pressure sore develop, the appropriate treatment. The assessment documents used to identify people who may be at risk from skin breakdown have also been changed and offer greater ability to identify people at risk. Changes in the way the care given to people is recorded and reviewed has overcome the problems identified in May when the deteriorating health of a number of people wasn’t immediately recognised. Care staff are now required to record their interaction with each person at the time it was given and to report concerns immediately to the Nurse in charge. The Nurses are obliged to review these daily notes prior to writing their nursing assessment. Also, the Nurses are expected work alongside the care staff each morning and are not permitted to administer medication prior to people having their breakfast (unless it has been prescribed to be given before meals) to enable them to have more contact with people and the care staff. A meeting was arranged each morning with the Nurses and the Acting Manager to discuss the care needs of each person in the home and any actions required such as referral to the GP or other health care professional. Nurses are responsible for administering medication and a measured dose system is used. This is a system that is prepared by the local pharmacist into sealed blister packs to reduce the risk of errors. Medication records, including those for controlled drugs, were neat and accurate. Of those people consulted, either through the use of surveys (16 out of 20 were returned) or in person, (28 people living in the home, not all of who could comment directly, and six relatives), three people raised concerns over the quality of the care and support provided. These concerns referred to the care for younger adults with complex care needs and leisure and social activities and the prevention of isolation, and keeping family informed of significant events. The Acting Manager and the newly appointed Manager were aware of these concerns and have taken steps to address these matters by meeting with Revelstoke Lodge DS0000003603.V367248.R01.S.doc Version 5.2 Page 13 everyone living in the home, their families and holding “Manager Surgeries” in the evenings: the timings of which were displayed on the notice board in the main foyer. Five of the six visiting families said they had been informed of the problems recognised at the May inspection but had complete faith in the home to overcome these. They confirmed that their relatives received excellent care and attention: these were families of both older and younger people living in the home. One family said their relative’s health and significantly improved since moving to Revelstoke Lodge and another said their relative “requires total care and the care staff do an excellent job”. Those people who were unable to comment directly about the quality of the service provided were seen to be comfortable and well groomed and their bedrooms were personalised and attractive. Staff were knowledgeable about their care needs and daily records were looked at and these had been well recorded. Revelstoke Lodge DS0000003603.V367248.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 7, 11– 15 and 17 (Adults 18-65) are: 12. 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 have opportunities for personal development. (YA NMS 11) Also Service Users are able to take part in age, peer and culturally appropriate activities. (YA NMS 12). Also Service users engage in appropriate leisure activities. (YA NMS 14) Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service Users are part of the local community. (YA NMS 13) Also Service Users have appropriate personal, family and sexual relationships. (YA NMS 15) Service users are helped to exercise choice and control over their lives. Service Users make decisions about their lives with assistance as needed. (YA NMS 7) Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. Service Users are offered a healthy diet and enjoy their meals and mealtimes. (YA NMS 17) 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15 and 17 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. Leisure and social activities provide stimulation and interest for the majority of people living in the home. Meals are varied and nutritious. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The majority of people able to comment about the opportunity to become involved in activities said they were pleased with the range and frequency of events organised by the Activity Co-ordinator. People were seen to be involved in a variety of activities in the lounge room and people confirmed that various Revelstoke Lodge DS0000003603.V367248.R01.S.doc Version 5.2 Page 15 trips to local places of interest were organised, such as The Eden project and Paignton Zoo. An activities room was available in addition to the lounge room where people could become involved with painting and other craftwork. Both the Activity Co-ordinator and staff said a number of people preferred not to become involved with group activities. Their preferences were not fully recorded on their care plans and three people felt that their needs were being overlooked. Staff confirmed that they spend time with people in 1-1 activities and this was evident throughout the 2 days of the inspection. The Activity Co-ordinator said that she would speak with each person in the home and/or their families to re-evaluate the activities they would like to be involved in. People described how the meals had improved significantly over the past few months since the new Chef had been employed. The Chef and catering staff were fully aware of those people who required assistance with their meals or who needed support with their nutrition. Menus were varied and provided nutritious meals. People confirmed they were able to ask for alternatives from the main menu and this was recorded in their daily care notes. Drinks and snacks were available at all times and vending machines with sweets and cans of drink were available in the room adjacent to the dining room. Revelstoke Lodge DS0000003603.V367248.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) 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 feel their views are listened to and acted on. (YA NMS 22) Service users’ legal rights are protected. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Service users are protected from abuse. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 17, 18. Quality in this outcome area is good. Complaints and concerns from people living in the home and their families are listened to and acted upon. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People spoken with and those who commented through the surveys said they know how to make a complaint and all but one person said that they are listened to. One person said she had to report her complaint to the organisation’s head office before she got the matter looked into: this was prior to the current management arrangements within the home. The Complaints procedure is displayed on the wall and a complaints and suggestion book is available in the main foyer where people can add their views anonymously if wished. Copies of the Service User Guide are available on the desk in the foyer and contain the name and address of the Commission should someone be dissatisfied with how the home is dealing with their concern. Revelstoke Lodge DS0000003603.V367248.R01.S.doc Version 5.2 Page 17 The newly appointed Manager said she operates an “open door” policy and is always available to meet with people. She has also arranged a number of “Manager Surgeries” in the evenings for people unable to visit the home during the day, to allow them to discuss with her any concerns they may have about the services at the home. The dates and times of these are detailed on the notice board in the foyer. Staff photographs are displayed for easier recognition of the staff employed at the home should someone want to comment directly about a member of staff. The Commission has received 2 complaints through social services regarding the quality of the nursing care provided at the home and these have been investigated through Plymouth City Council’s Adult Protection Procedures. The outcome of these investigations was that the home had failed in its duty to ensure the nursing care provided to people met their needs and protected them from deteriorating health. Changes have been made with the appointment of the Acting Manager to ensure people’s needs do not go unrecognised or unmet in future. Staff reported that communication within the home between themselves and the Nurses as well as the management team has improved significantly and this had addressed many of the concerns over poor communication and practice in the months since the previous Registered Manager left. The training records indicated that all but 2 of the 52 staff had received training in the protection of vulnerable adults and those staff spoken with were aware of their responsibilities should they suspect someone was at risk of abuse. Revelstoke Lodge DS0000003603.V367248.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) Service users have access to safe and comfortable indoor and outdoor communal facilities. Shared spaces complement and supplement service users’ individual rooms. (YA NMS 28) Service users have sufficient and suitable lavatories and washing facilities. Service Users toilets and bathrooms provide sufficient privacy and meet their individual needs. (YA NMS 27) Service users have the specialist equipment they require to maximise their independence. (YA NMS 29) Service users’ own rooms suit their needs. Service Users’ own rooms suit their needs and lifestyles. (YA NMS 25) Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. (YA NMS 26) Service users live in safe, comfortable surroundings. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) The home is clean, pleasant and hygienic. The home is clean and hygienic. (YA NMS 30) The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25, 26. Quality in this outcome area is good. Revelstoke Lodge provides a comfortable and safe home, suitable for the needs to those currently living there. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A tour of the home was undertaken and all rooms were found to be clean and free from offensive odours. The home employs a team of housekeeping and laundry staff to oversee the cleaning of the home and these staff were aware Revelstoke Lodge DS0000003603.V367248.R01.S.doc Version 5.2 Page 19 of their responsibilities to maintain the cleanliness of the home. Liquid soap and paper hand-towels, as well as protective clothing such as gloves and aprons were available to reduce the risk of cross infection. Twenty-seven staff had attended Infection Control training this year to ensure they understood the principles of good practice to prevent the spread of infection. Refurbishment of the home continues with bedrooms being decorated as necessary. One bathroom on the ground floor was being converted to a bathroom suitable to be used by people with restricted mobility, a carpet in the upper hallway was due to be replaced and one of the ground floor bathrooms where the tiles have been cracked due to being hit by wheelchairs moving in and out of the room was due to be repaired. The Acting Manager gave assurances that these repairs would be completed over the next few weeks. Walk-in/wheel-in shower rooms, assisted baths, raised toilet seats and grab rails all provide assistance to people with restricted mobility to be as independent as possible with their personal care and moving around the home. A passenger lift provides access to all floors. Radiators were covered and the temperature of the hot water was controlled to protect people from the risk of burns and scalds. The laundry room and kitchen are situated on the lower ground floor and were found to be clean and tidy. Level access to the garden is available from this floor and the garden was being landscaped at the time of the inspection in June to provide shaded sitting areas as well as flower beds and a water feature. Once completed this will provide a pleasant and safe area for people to enjoy. Revelstoke Lodge DS0000003603.V367248.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 35 (Adults 18-65) are: 27. 28. 29. Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. (YA NMS 33) Service users are in safe hands at all times. Service Users are supported by an effective staff team. (YA NMS 32) Service users are supported and protected by the home’s recruitment policy and practices. Service Users benefit from clarity of staff roles and responsibilities. (YA NMS 31) Also Service Users are supported and protected by the home’s recruitment policy and practices. (YA NMS 34) Staff are trained and competent to do their jobs. Service Users individual and joint needs are met by appropriately trained staff. (YA NMS 35) 30. The Commission considers standards 27, 28, 29 and 30 (Older People) and Standards 32, 34 and 35 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is good. People are supported by trained staff in sufficient numbers to meet the needs of those currently living in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Revelstoke Lodge has a comprehensive training programme to ensure staff are provided with the information they need to recognise people’s needs and how to keep people safe. Training includes Food Hygiene, for all staff not just catering staff; Health and Safety; Infection Control; Tissue Viability; Nutrition; Safe Medication Practice; Fire Safety and Adult Protection. The newly appointed Manager said that she was arranging for updates in specific health conditions such as Huntingtons’ Disease to ensure are able to support people with complex and progressive diseases. Revelstoke Lodge DS0000003603.V367248.R01.S.doc Version 5.2 Page 21 The home employs 10 trained nurses and 42 care staff. The majority of the care staff either have, or are in training for, a National Vocational Qualification in Care. All staff spoken with recognised that the recent failings of the home resulted from poor communication and lack of leadership since the Registered Manager left in February. Staff had not been fully aware of who was responsible for what action and this has been addressed by the Acting Manager who has made it clear that Nursing staff are responsible for ensuring people’s need are being fully met and people are safe. Care teams have been established with a keyworker system and named Nurse ensuring each member of staff knows who to report to and each Nurse knows of their responsibilities. Each Nurse has had their skills and competence assessed and a training and development plan identified. Every member of staff has received supervision from the Acting Manager since the inspection in May and an ongoing programme of supervision has been established which shares responsibility within the senior management team in the home to ensure care staff are supported to develop their own skills. Two people spoken with thought there were insufficient staff employed at the home and that at times they had to wait for the call bell to be answered. At the time of the inspection there were 28 people living in the home and there were eight care staff on duty with two Nurses, as well as the Acting Manager and newly appointed Manager, the Activity Coordinator, housekeeping, laundry and administration staff. The Acting Manager said that these numbers were sufficient to meet the needs of those currently living in the home. The recruitment files of the most recently recruited staff were examined. All contained the necessary pre-employment checks including 2 written references and a Criminal Record Bureau check, ensuring as far as possible only suitable staff are employed. Revelstoke Lodge DS0000003603.V367248.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 8, 10, 23, 37 – 43 (Adults 18-65) are: 31. 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 a well run home. (YA NMS 37) Service users benefit from the ethos, leadership and management approach of the home. (YA NMS 38) The home is run in the best interests of service users. Service Users are consulted on and participate in, all aspects of life in the home. (YA NMS 8) Also Service Users are confident their views underpin all selfmonitoring, review and development by the home. (YA NMS 39) Service users are safeguarded by the accounting and financial procedures of the home. Service Users benefit from competent and accountable management of the service. (YA NMS 43) Service users’ financial interests are safeguarded. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Staff are appropriately supervised. Service Users benefit from well supported and supervised staff. (YA NMS 36) Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. Service Users know that information about them is handled appropriately, and that their confidences are kept. (YA NMS 10) Also Service Users rights and best interests are safeguarded by the home’s policies and procedures. (YA NMS 40) and (YA NMS 41) The health, safety and welfare of service users and staff are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (YA NMS 42) 32. 33. 34. 35. 36. 37. 38. The Commission considers standards 31, 33, 35 and 38 (Older People) and Standards 37, 39 and 42 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35, 36, 37 and 38. Quality in this outcome area is good. Recent changes to the management structure of the home has addressed the significant failings of the service identified in May and people can now be assured that they are supported in a safe, well managed home. This judgement has been made using available evidence including a visit to this service. Revelstoke Lodge DS0000003603.V367248.R01.S.doc Version 5.2 Page 23 EVIDENCE: Both social services and the Commission identified serious failings in the management of the welfare of people living in the home in May 2008. The previous Registered Manager left the home in February 2008 and this saw a decline in nursing standards. Southern Cross Healthcare have acknowledged this and they have given commitments to the Commission they recognise these failings are unacceptable and are determined to ensure no other person living in the home is let down. A Senior Manager from within the organisation was appointed Acting Manager to oversee the necessary changes within the home prior to the new Manager starting on 23rd June 2008. The Acting Manager stayed at the home to ensure he had access to every member of staff including the night staff. Those staff spoken with confirmed he had met with each of them to identify their own needs and to address the recent issues within the home. Staff said that he was approachable and listened to what they had to say. They confirmed there was a better team structure and morale had improved significantly. Staff said they were determined for Revelstoke Lodge to regain its good reputation. The newly appointed Manager is a trained Registered Nurse in Adult Nursing, has a National Vocational Qualification in Care at level 4 as well as the Registered Manager Award and a nursing qualification specifically in the Care of the Elderly. She has many years experience in managing care homes and said it was her intension to register with the Commission. Southern Cross Healthcare has a companywide quality audit process which involves an Area Manager sampling and assessing the quality of the service provided. The Acting Manager has undertaken a number of audits including care planning, medication practices, catering services and the maintenance of the home. He and the newly appointed Manager will be undertaking formal consultation with people living in the home and their relatives to resolve any issues of concern and to identify what the home does well. The home employs staff to undertake day-to-day maintenance tasks as well as overseeing the servicing of equipment such as the fire alarm system and the passenger lift and lifting hoists. People are encouraged to retain responsibility for their own finances, however for those who are unable the home offers support. Southern Cross Healthcare has an interest bearing bank account where people can deposit their money for safe keeping. Money is withdrawn upon request or taken from petty cash if Revelstoke Lodge DS0000003603.V367248.R01.S.doc Version 5.2 Page 24 needed at short notice. Interest is calculated on an individual basis and an accountant is employed by the company to ensure each person has the correct amount of interest due to them. All expenditure and money received (including interest) was documented and double-checked each week by the home’s administrator. Revelstoke Lodge DS0000003603.V367248.R01.S.doc Version 5.2 Page 25 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 3 2 X 3 3 4 3 5 3 6 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 ENVIRONMENT Standard No Score 19 3 20 3 21 3 22 3 23 3 24 3 25 3 26 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No Score 31 3 32 3 33 3 34 3 35 3 36 3 37 3 38 3 Revelstoke Lodge DS0000003603.V367248.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP8 Regulation 12(1)(b) Requirement The Registered Provider must ensure that people receive the appropriate care and attention to maintain their health and safety. Timescale for action 31/07/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP7 Good Practice Recommendations For those people who have been advised to undertake specific exercises to strengthen muscle tone should have these recorded in their care plan and also in their daily notes. Should someone not wish to undertake these exercises, this should also be recorded in their daily notes. People who prefer not to undertake group activities should be offered more individualised leisure activities. 2 OP12 Revelstoke Lodge DS0000003603.V367248.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI. Revelstoke Lodge DS0000003603.V367248.R01.S.doc Version 5.2 Page 28 - 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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