Inspection on 29/11/05 for Rheola

This inspection was carried out on 29th November 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 25/05/05

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 Inspection 29th November 2005 10:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Rheola DS0000015108.V257423.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Rheola DS0000015108.V257423.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Rheola Address Broad Leas St Ives Cambridgeshire PE17 4PU 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) 01480 375163 01480 375160 Excelcare Holdings Jeanette McNally Care Home 42 Category(ies) of Dementia - over 65 years of age (13), Old age, registration, with number not falling within any other category (32) of places Rheola DS0000015108.V257423.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered to accommodate up to 32 people in the category OP & up to 13 people in the category DE(E) 25th May 2005 Date of last inspection 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 Huntingdon Primary Care Trust to provide 6 respite care beds and has recently agreed with the PCT to provide up to 3 Intermmediate Care beds. Rheola DS0000015108.V257423.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One inspector conducted this inspection. Several service users were spoken to, staff interaction with service users was observed and a lunchtime meal was observed being served. Care planning arrangements were discussed with the Manager and the acting Operations Manager. 1 of the 2 requirements that were made at the last inspection had been met whilst the other was partially met. 3 of the 5 recommendations made in the last report were met and one was repeated in this report. 15 relatives/visitors comments card were returned to the CSCI and 30 service users’ comment cards were returned. 9 relatives comment cards expressed dissatisfaction with staffing levels. The easy and uncontrolled access into the home was seen by visitors as a security risk and a risk to service users. These concerns seem to be upheld because the staffing levels indicate that visitors to the home are able to enter or leave the premises undetected. The levels of staffing cannot provide the attention necessary to stimulate or to improve service users’ emotional and psychological wellbeing through interaction, especially for those service users whose mobility is reduced and who are spending long periods alone in their rooms. Other comments made were about the lack of social interaction when food is being served; poor variety of food; the shortage or small staffing numbers at weekends; the oversight of routine tidiness in service users rooms. The majority of the service users’ comment cards indicated their overall satisfaction with their care. The next inspection will assess the views of service users more thoroughly and will seek the views of relatives/ visitors. More care staff will be spoken to and an assessment of weekend staffing arrangements will be considered. What the service does well: The last report included the following: • Rheola is a large and spacious home that provides sufficient individual space and privacy. • 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. Rheola DS0000015108.V257423.R01.S.doc Version 5.0 Page 6 • • 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. 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. The same aspects of care also apply to this report. The performance of the home should take into consideration their role as providers of temporary respite and intermediate care and their high percentage of service users who are admitted. The home have to manage the changing care needs and have to become familiar with and adaptable to a larger number of service user than they might normally cope with. This profile of service user ‘turnover’ must be measured more systematically and comprehensively when measuring dependency levels to determine staffing numbers, their skill mixes and abilities. What has improved since the last inspection? What they could do better: • It is recommended that Care Plans should be more concise and less cumbersome so they are easier for care staff to use. They must include information relating to their Intermediate Care aims where applicable. DS0000015108.V257423.R01.S.doc Version 5.0 Page 7 Rheola • The security of the home should be improved so the main entrance set of doors are fitted with a locking device and have coded entry system intended to protect the safety and security of service users. This aspect of security in the home was discussed with the Manager and acting Operations Manager. Staff induction arrangements must include as the main priority, training in the protection of vulnerable adults. The revised social care induction standards have been set by Skills for Care, the National workforce development agency, who have identified with the CSCI, 6 new standards of care to be included in for social care induction training. Protecting vulnerable adults from abuse is a Code of Conduct set by the General Social Care Council and is reflected in NVQ training and came into force in September 2005 and will probably be compulsory in 2006. Protection from abuse should be the basic philosophical approach and ethical principle to care giving. Staffing levels are recommended to increase as suggested in the ‘Staffing’ section of this report. Dependency levels must be cross referenced with staffing arrangements in a systematic method that quantifies the combined and fluctuating and time related needs of each service user that acts as a guide for staffing numbers. This monitoring of staffing levels could be adopted as a quality assurance approach and considered as an action to ensure service users safety and wellbeing. More staff should have falls prevention training. • • • • 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. Rheola DS0000015108.V257423.R01.S.doc Version 5.0 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Rheola DS0000015108.V257423.R01.S.doc Version 5.0 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5,6, 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 Primary Care Trust’s (PCT) commissioning 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. Rheola DS0000015108.V257423.R01.S.doc Version 5.0 Page 10 Intermediate care to facilitate hospital discharge is provided by the home. The home have agreed a policy with the PCT of not segregating the intermediate care service user but instead accommodate these service users, who may need rehabilitative care or may be awaiting social care home care arrangements, in any one of the rooms vacant at the time of admission. A report from the Transitional Care Team has included positive comments about the intermediate care arrangements and the ability of the home’s staff to indicate whether they are able (or not) to manage the needs of prospective service users identified for intermediate care. The manager stated that she had refused admission for some prospective service users because their needs were considered to be in excess of the care the home could provide. Rheola DS0000015108.V257423.R01.S.doc Version 5.0 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,11, Care plans revealed sufficient care planning apart from insufficient details recorded for service users receiving intermediate care. EVIDENCE: Three care plans were read that indicated overall attention to a range of needs. These plans were well recorded. The Plans could be improved by being concise and focused on what care is needed and how it should be given and with the person being described. This was discussed with the Manager during the inspection. Intermediate care details had not been fully included in one Care Plan and these must be recorded in the Plan. Staff spoken to during the day expressed a good knowledge of service users’ needs and approaches to their individual needs that were not recorded one person’s Care Plan. One service user had been included in his care planning arrangements and had been kept informed of the developments about his anticipated move to an other home of his choice. Rheola DS0000015108.V257423.R01.S.doc Version 5.0 Page 12 Rheola DS0000015108.V257423.R01.S.doc Version 5.0 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13,15, Nutritious warm meals are provided at lunchtime and these are appropriate to the needs of service users. EVIDENCE: A nutritional and well-presented meal was observed being eaten by service users in the three dining rooms used by service users. Observations were made in the three dining rooms in Rose suite, Thistle suite and the combined Daffodil and Shamrock dining areas and a conversation with one person eating alone in his room. These observations revealed that sufficient supervision during mealtimes seemed to be taking place and no service user was noticed to be left unassisted or neglected. Most service users had eaten all of their food. Rheola DS0000015108.V257423.R01.S.doc Version 5.0 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None assessed EVIDENCE: Rheola DS0000015108.V257423.R01.S.doc Version 5.0 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,23,24,25,26, The environment is comfortable and clean but could be made safer. EVIDENCE: Rheola is a large home on two floors with spacious corridors. The entrance has automatic opening doors that make access to the home very easy. This easily accessible entrance system should be made more secure for certain periods and the methods of achieving this were discussed with the Manager and acting Operations Manager during the inspection. The Manager agreed to consult with relatives about their intentions to make access to the home more secure and safer for service users. The home was very clean and well maintained on the day of inspection. Service users room were individualised with their preferences and personal belongings. This paragraph relates to the management of the fire safety equipment and is repeated in the management section. The fire safety procedures have been Rheola DS0000015108.V257423.R01.S.doc Version 5.0 Page 16 criticised by the Cambridgeshire Fire and Rescue Service in their letter of the 01/11/2005. Their points for action have been attended to by the home and at the time of this inspection were awaiting further risk assessment by the Fire Officer. One member of staff confirmed the weekly testing of fire alarms points. Rheola DS0000015108.V257423.R01.S.doc Version 5.0 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,29,30, More effort must be made to guarantee staffing levels are sufficient to meet all service users needs. EVIDENCE: The home has attracted a number of concerns about their staffing levels, especially at weekends. The inspector discussed with the manager and acting operations manager the home’s profile of service users high ‘turnover’ due to the respite provision and arrangements “block purchased” by the PCT and the provision of Intermediate Care. In addition the home has to meet the dementia related needs of 13 service users. The home has a changing population of service users with variable needs and in reality more than 13 persons are likely to have some degree of dementia related needs. The home should establish a method of systematically cross referencing measured and recognised dependency levels to staffing numbers and what their skill levels and mix should be. This is not adequately demonstrated by the home. The staff roster was read and the manager stated here are 6 staff and a Team Leader working from 8am to 8pm every day and there are 3 staff working on the opposite 12-hour night time shift. On average there are 5 staff for 42 service users an average ratio of 1 member of staff for 8.4 service users. The highest staffing ratio is 1to 6 and the lowest staffing ratio is 1to 14. In the extra care suite there are always 2 staff for 10 service users and assistance at meal times is provided by an additional member of staff for 5 days each week. In the Thistle suite there are up to 12 service users and one member of staff plus the assistance of the Team Leader. There are 20 service users and two Rheola DS0000015108.V257423.R01.S.doc Version 5.0 Page 18 staff in the combined Daffodil and Shamrock suites. The team leader has responsibilities for supervision and other administrative tasks that take her away from providing personal care and therefore the staffing ratio during the daytime is adversely affected. However the manager stated there are times when she has provided personal care when the staffing situation demands this and that she monitors the daily needs of service users to ensure sufficient numbers of staff are present. Staff who work in each suite have responsibilities for administering medication. Observations made in the three dining rooms in Rose suite, Thistle suite and the combined Daffodil and Shamrock dining areas and a conversation with one person eating alone in his room during lunchtime did not record the Team Leader providing assistance. However, these observations revealed that sufficient supervision during mealtimes seemed to be taking place and no service user was seen to be left unassisted or neglected. In the light of the above circumstances it is recommended the home employs 7 care staff plus the Team Leader for the 12 hour working day shift to improve the low staffing ratio and to guarantee a minimum of 7 care staff plus the additional monitoring and assistance with personal care expected from the Team Leader or Manager. Staff induction arrangements were read and it was agreed they must include as the main priority, training in the protection of vulnerable adults. The revised social care induction standards have been set by Skills for Care, the National workforce development agency, who have identified with the CSCI, 6 new standards of care to be included for social care induction training. Protecting vulnerable adults from abuse is a Code of Conduct set by the General Social Care Council and is reflected in NVQ training and came into force in September 2005 and will probably be compulsory in 2006. Staff training has improved and is recorded in a new improved training matrix that revealed that more staff have started NVQ courses. Dementia care training is being managed from an in-house trainer and most staff have received this training and more staff are booked to undertake this training. All training courses are made known to all staff. All staff have received Protection will have received the training for, “Protection of Vulnerable Adult from Abuse” by the 08/12/2005. Rheola DS0000015108.V257423.R01.S.doc Version 5.0 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,38, Service users’ best interests are upheld by the attitude and approach shown by the management. EVIDENCE: Service users best interests are met by the open style of management and by the organisation’s range of policies and guidance designed to protect staff and service users that have met Standard 37 in previous inspection reports. Two lists of relatives’ and residents meeting have been scheduled and were posted in the manager’s office. The manager said that she had informed all known next of kin of these meetings. The fire safety procedures that must be adhered to have been criticised by the Cambridgeshire Fire and Rescue Service in their letter of the 01/11/2005. Their points for action have been attended to by the home and at the time of Rheola DS0000015108.V257423.R01.S.doc Version 5.0 Page 20 this inspection were awaiting further risk assessment by the Fire Officer. One member of staff confirmed the weekly testing of fire alarms points. Staff meetings and their involvement in the home and service user involvement were not assessed during this inspection as intended, but will be included in the assessments of the next inspection. Complaints known to the CSCI and the responses offered by manager and operations manager have indicated their co-operation and willingness to accept complaints and allegations and to answer these concerns. In November 2005 the result of the questionnaires they offered to all relative and friends and the results revealed a general satisfaction with the home based on 50 questions. The negative and positive comments had been equally stated. Rheola DS0000015108.V257423.R01.S.doc Version 5.0 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 X 10 X 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 3 3 3 X 3 3 3 3 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X X X X 1 Rheola DS0000015108.V257423.R01.S.doc Version 5.0 Page 22 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 OP7 Regulation 15(1) Requirement Care Plans must include information relating to service user’s Intermediate Care aims where applicable. Dependency levels must be cross-referenced with staffing arrangements. A systematic method that quantifies the combined and fluctuating and time related needs of each service user must be used as a guide for determining staffing numbers. Staff induction arrangements must include as the main priority, training in the protection of vulnerable adults from abuse. The attention to emergency routes and maintenance requirements made by the Cambridgeshire Fire and Rescue Service in their letter of the 01/11/2005 must be carried out. Timescale for action 01/01/06 2 OP27 18(1)(a) 01/01/06 3 OP30 18 (1)(c(i)) 01/01/06 4 OP38 23(4)(a) (b)(c ) 01/01/06 Rheola DS0000015108.V257423.R01.S.doc Version 5.0 Page 23 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 It is recommended that Care Plans should be improved by being concise and focused on what care is needed and how it should be given and with the person being described. The security of the home should be improved so the main entrance set of doors are fitted with a locking device and have coded entry system intended to protect the safety and security of service users. Staffing levels should be increased as suggested in the ‘Stafffing’ section of this report. More staff should have training in “Falls prevention”. Person centred care should be considered as a topic for training. 2 OP19 3 4 5 OP27 OP30 OP30 Rheola DS0000015108.V257423.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Cambridgeshire & Peterborough Area Office 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 DS0000015108.V257423.R01.S.doc Version 5.0 Page 25 - 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!