Inspection on 25/05/05 for Rheola

This inspection was carried out on 25th May 2005.

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

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

Other inspections for this house

Rheola 22/08/07

Rheola 21/09/06

Rheola 29/11/05

Rheola 14/12/04

Rheola 20/05/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Rheola Broad Leas St Ives Cambridgeshire PE17 4PU Lead Inspector Don Traylen Announced 25 May 2005 @ 10:00 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Rheola Version 1.10 Page 3 SERVICE INFORMATION Name of service Rheola Address Broad Leas St Ives Cambridgeshire PE17 4PU 01480 375163 01480 375160 dianejay@excelcareholdings.com Excelcare Holdings plc Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Jeanetta McNally Care Home 42 Category(ies) of Dementia, over 65 years of age (DE(E)) = 13, registration, with number Old age, not falling into any other category (OP) of places = 32 Rheola Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 14/12/2004 Brief Description of the Service: Rheola is a care home registered to provide for a total of 42 elderly people including 13 people with Dementia related care needs. Originally a Local Authority care home it was aquired by Excelcare Holdings in 2001. The home is situated a few minutes walk from St Ives town centre. It is a large house that has been converted to a care home and has had an extension added to the rear of the building. There are well kept gardens to the rear and side of the property. Each bedroom has a washhand basin. Twelve rooms have full ensuite facilities. The home is divided into four units Rose, Thistle, Shamrock and Daffodil. Each suite has a separate dining room, lounge, kitchen, toilets and bathroom. Rose suite is single storey extension that provides accommodation for 10 people who have extra care needs related to their mental health. Thistle and Shamrock suite each have 12 bedrooms whilst Daffodil suite has 8 bedrooms. The home has a contractual agreement with the PCT to provide respite care. Rheola Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Not all of the standards were assessed during this inspection. The Operations Manager, the Registered Manager and a Team Leader were present on both days of the inspection. The inspector spoke to 6 service users and 3 relatives during the inspection and observed the interaction between several service users and staff. 15 Relatives/Visitors comment cards were returned and 31 service users were assisted by a visiting relative to complete their comment cards. 5 of the 15 Relative/visitors comment cards reported 4 negative comments and 3 of the 31 service users’ cards contained 1 negative and 1 positive comment about the home. The issues raised were about staffing levels and an unpleasant odour in a bedroom. What the service does well: • • Rheola is a large and spacious home that provides sufficient individual space and privacy. Training is delivered in a manner that enables all staff to have equal access to an appropriate range of training topics. Training in protecting vulnerable adults from abuse and for dementia related care have been extended to more care staff. Pre-admission arrangements made by the home are thorough and ensure that the home is aware of service users’ capabilities and needs. The admissions process shows that no service user is admitted unless the home has carefully assessed and considered a person’s needs. The home manages to provide care for a significant number of service users who have short stay respite periods. The home adequately manages this “turnover” of service users by ensuring the accuracy of service users’ assessment details. The service users who reported they were satisfied and happy with their care indicated there are benefiting from a home were they are well cared for and have confidence in the care staff. • • • Rheola Version 1.10 Page 6 What has improved since the last inspection? What they could do better: • The home should consider increasing the number of staff on duty so there is a higher ratio of care staff to service users. The home should risk assess and consider the effects of 12-hour shifts worked by care staff and review and monitor this arrangement. The effects on care staff and service users should be included in this monitoring and analysis. The 12hour night shift that operates from 8pm to 8am should accommodate the availability of more staff during the busier periods, such as the end and start of night shifts and when medication needs to be administered. The system for checking service users during the night has agreed to be reviewed by the Operations Manager so that service users benefit from a system that ensures they are comfortable and free from risk of overheating. The manager should seek to continue to improve upon the training arrangements that have been started. A new training analysis matrix that indicates the current training arrangements and the identified training needs for the immediate future should be made. All staff must be offered NVQ level 2 training so that all staff have equal opportunities to achieve the NVQ level 2 award in care. All staff must undertake the protection of vulnerable adults from abuse training as part of their induction programme. The manager should consider arranging refresher courses for staff in protecting vulnerable adults from abuse, as a matter of good practice. A person-centred approach to the individual interaction between service users and staff, should be further developed so that staff have the time to make extra efforts to talk to service users in their routine functions • • • • • • Rheola Version 1.10 Page 7 and tasks. This should be encouraged and facilitated so the outcome is the provision of an enhanced socially stimulating environment. Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Rheola Version 1.10 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Rheola Version 1.10 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,3,4,5, The admissions process for prospective service users ensures that the home has adequate information on which to make a judgement about meeting a prospective service user’s care needs. EVIDENCE: The manager informed the inspector that a comprehensive Care Management assessment is expected for any prospective service user. If a service user is self-funding, a Care Management assessment is still expected. In either case, the home carries out an assessment prior to admission usually by visiting a service user in their home or hospital. A trial period of 4-6 weeks is offered in line with the PCTs’ placement arrangements. The manager stated that families usually always visit prior to an admission. Relatives who spoke to the inspector stated they had been involved in the home’s admissions process and had also been consulted in the assessment and care planning carried out by the home. Intermediate care is not provided by the home, but the Operations Manager informed the inspector that arrangements are being considered and negotiations with the PCT to provide Intermediate care are in progress. Rheola Version 1.10 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,10,11, Care Plans are satisfactorily well-developed. Service users are treated with respect. EVIDENCE: Care Plans read at the last inspection indicated this standard was met. One service user’s Care Plan that was read contained extensive detailing about her care arrangements and it was clear that the home had addressed a recent change in her needs. The Care Plan was a very informative document that met Standard 7. Information included dependency levels scored for communication, circulation, nutrition and range of other functions. The inspector discussed with the manager and Operations Manager their intentions to add further details to the Care Plan concerning the specialist arrangements made by a Social Worker to meet the alternating needs of one service user. The manager and Operations Manager discussed how the home is intending to make the written Care Plans more person centred and descriptive. Another Care Plan included a full description of the events and reasons concerning an appropriate admission to hospital. One Care Plan indicated that there were unreliable changes in the dependency levels that had been Rheola Version 1.10 Page 11 recorded. This was discussed with the manager and the Operations Manager and agreed they would re-assess each service user’s dependency score. Although a Requirement has been made in this report in relation to the recording of dependency levels, they are significant for determining staffing numbers and the Requirement has therefore been made in relation to Standard 27. Staff were observed to knock on service users’ doors and ask if they could enter. One confused service user was empowered by the attention given to her by a member of staff. The service user smiled and was stimulated by the attention afforded her by this member of staff who spoke to her in a respectful manner. The home has a policy to care for service users at a time of death and will seek help from Community Nurses when this is appropriate. In such circumstances the home might occasionally be able to provide overnight accommodation for a visiting relative. Medication records were not read during this inspection but will be assessed at the next inspection. During discussions with the Operations Manager, it was agreed the home would revise their system for checking service users during the night. Rheola Version 1.10 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14,15, Service users are afforded choices and family contacts are encouraged by the home. EVIDENCE: Eight of the service users and relatives spoken to stated they were satisfied with the home. One relative of a recently admitted service users stated this is “the best home” she knew and another commented she was “more than satisfied”. Four relatives who regularly visit the home spoke to the inspector and reported they had been involved in the admission and care planning arrangements and had developed good relations with the manager and staff and felt able to exercise control over the care of their relatives. A nutritional and well-presented meal was observed being served to service users during the inspection a menu of a balanced and sufficient diet is recorded and that also incorporates service users who have diabetic needs. Rheola Version 1.10 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,17,18, Complaints and the protection of service users are dealt with thoroughly and competently by the organisation. EVIDENCE: The home maintains a Complaints ‘log book’ that included details and actions taken about the complaints made to the home. The manager and the Operations Manager appropriately dealt with one complaint that involved the CSCI during this inspection. Service users and relatives stated they felt they could comfortably raise a concern with the manager should they wish. All staff are trained in adult protection procedures. It is recommended as good practice, that staff receive training in the protection of vulnerable adults as part of their Induction training programme and have the opportunity to receive ongoing refresher training in this same subject. Rheola Version 1.10 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,21,22,23,24,25,26, The home is suitably equipped and is safely maintained for the service users’ needs and habits. EVIDENCE: Two rooms were being redecorated during the inspection. One room smelled slightly of urine and when this was discovered the Operations Manager arranged for the carpet to be immediately changed and this eradicated the odour. One toilet that had recently been used was in need of being cleaned and the manager arranged for this to be immediately attended to. Apart from these two instances the home was very clean and tidy. It is recommended that a system for identifying and reporting unsatisfactory hygienic standards is implemented and should become the responsibility of all staff. The home is a large building that has inherent problems associated with staffing levels. However, the advantages outweigh the disadvantages because the home is more than adequate for service users to be private or as social as they choose whilst having sufficient ‘personal space’. The extra care part of the home is separate and may be a slightly confining environment for some Rheola Version 1.10 Page 15 service users and might be a area for future re-assessment of how it is best suited for individual service users’ needs. An Environmental Health report under the Food Safety Act was carried out on the 09/03/2005 and stated that, “conditions are greatly improved”. The home has introduced a regular cleaning check programme based on a risk assessment carried out by the home. Rheola Version 1.10 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,29,30, The staffing levels are adequate and meet service users needs. A rigorous recruitment process helps to protect service users. EVIDENCE: 5 staff are completing an NVQ level 2 award in care and 2 staff have completed an NVQ level award. 3 Romanian nurses are working as care assistants and are receiving English language tutoring. Approximately 10 of staff have an NVQ level 2 award. The manager agreed that it is appropriate for all care staff to be expected to undertake NVQ level 2 training and a Requirement has been made in relation to this. The home operates a thorough recruitment process that expects two references, a satisfactory CRB for all staff prior to commencing employment. An induction programme is expected to be successfully completed by all staff. The daytime rota is arranged from 8 am –8pm and the reverse is considered as night rota. The home operates a staffing compliment of 5 care workers, a team leader, who also carries out personal care, the manager and a part-time activities co-ordinator and domestic staff who work the day time roster. The manager stated this was the usual staffing compliment but she would employ additional staff if this were necessary. 3 care staff work the night shift. A daytime ratio of 1 staff to 7 service users and a night time ration of 1 to 14 is a 24 hour average of 1 to 10, allowing for a slightly reduced number of service Rheola Version 1.10 Page 17 users. On the day of inspection there were 32 service users living in the home which amounted to an average staff to service user ratio of 1 to 7. The inspector discussed with the manager and Operations Manager that the staffing levels should be a calculated response to the needs of service user and that the home is a large environment for staff to manage. The home has a system for measuring the dependency level of each service user that is used to calculate the staffing numbers. A Requirement has been made for the dependency levels for each service user to be rigorously reviewed to ensure that staffing levels are sufficient. Whilst it was not found that service users needs were unmet, a review of staffing skills and numbers, informed by a review of dependency levels of service users, should be made. It is significant that the home provides a high turnover of respite care, an arrangement that can present unknown, new and continuously differing needs and is considering providing Intermediate care. The home employs 5 domestic staff, a housekeeper, 3 cooks, a maintenance person and an activities co-ordinator. The manager stated that the home has an ongoing programme designed to provide dementia care training to all care staff. The manager and inspector discussed how person-centred care and dementia care are related and that a definite person-centred approach to giving care is hoped to evolve from this training. It was observed that there were two instances of very positive personal interaction between one member of staff and service users when service users were fully involved in verbal discussions and on another occasion when less verbal interaction was taking place but the service user was interacting with the care worker and was clearly empowered through this interaction. Rheola Version 1.10 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,35,36,37, Service users benefit from a home that has an open management approach, an ethos based on respect and where service users bests interests are promoted. EVIDENCE: Since the last inspection a new registered manager has been approved. The registered manager has completed and NVQ level 4 in Management. Staff supervision is arranged on a one-to-one basis, is recorded and is regularly provided to staff. One member of staff stated that she was supported through her supervision sessions. Service users finances are not managed by the home. Staff meetings and their involvement in the home and service user involvement will both be inspected at the next inspection. The organisation has a range of policies and guidance designed to protect staff and service users that have met Standard 37 in previous inspections. Rheola Version 1.10 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 x 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 3 3 3 3 3 3 2 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 3 x x x 3 3 3 x Rheola Version 1.10 Page 20 no Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 7 & 27 Regulation 18 (1)(a) & 15(2)(b) Requirement The methods used for assessing and recording dependency levels of service users must be reviewed and inform the Care Plan and must be used to determine the staffing arrangements necessary to meet the needs of service users. All staff must be offered the opportunity to undertake an NVQ level 2 award in care. None Timescale for action 01/09/05 2. 3. 28 18(1)(c ) 01/07/05 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 18 Good Practice Recommendations To ensure the protection of vulnerable adults from abuse the staff induction programme should include training in the protection of vulnerable adult from abuse and to receive ongoing refresher training in this subject. As good practice and as a quality assurance method, there should be a system that encourages any member of staff, or visitor, to report or comment on the standard of hygeine. The home should risk assess the 12 hour shifts worked by Version 1.10 Page 21 2. 26 3. Rheola 27 4. 5. 30 30 staff and should determine if additional staff are needed during busier periods such as the times when medication is being administered, or at the end and beginning of the twelve hour night shifts. A new training matrix analysis that indicates training achieved, the future traning needs and training that has been planned for. Person-centred care should be developed and provided as a subject for staff training. Rheola Version 1.10 Page 22 Commission for Social Care Inspection CPC1, Capital Park Fulbourn Cambridge CB1 5XE National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Rheola Version 1.10 Page 23 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!