Inspection on 01/11/06 for Ringshill Nursing Home

This inspection was carried out on 1st November 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Ringshill Nursing Home 08/04/08

Ringshill Nursing Home 12/04/07

Ringshill Nursing Home 16/05/06

Ringshill Nursing Home 25/01/06

Ringshill Nursing Home 23/08/05

Ringshill Nursing Home 11/01/05

Ringshill Nursing Home 20/07/04

Ringshill Nursing Home 05/03/04

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 Ringshill Nursing Home Sallowbush Road Huntingdon Cambridgeshire PE29 7AE Lead Inspector Elaine Boismier Key Unannounced Inspection 1st November 2006 10:15 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 Ringshill Nursing Home DS0000024297.V317720.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. 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. Ringshill Nursing Home DS0000024297.V317720.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ringshill Nursing Home Address Sallowbush Road Huntingdon Cambridgeshire PE29 7AE 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 411762 01480 450940 www.fshc.co.uk Ringdane Limited (wholly owned subsidiary of Four Seasons Health Care Limited) Care Home 87 Category(ies) of Old age, not falling within any other category registration, with number (87) of places Ringshill Nursing Home DS0000024297.V317720.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. No more than 61 nursing care beds Date of last inspection 16th May 2006 Brief Description of the Service: Ringshill Nursing Home is on the edge of a large housing estate on the outskirts of Huntingdon. There is a local bus service serving the area. It is a short walk from a general store and within easy driving distance of the town of Huntingdon. The accommodation is on two floors with the upper floor being served by two lifts. The ground floor accommodates residential care clients and the upper floor for those who need nursing care. Nursing and care staff are employed, night and day, and there are domestic, catering and maintenance staff also employed. Fees currently range from £351 to £623. Additional costs include hairdressing, toiletries, private chiropody and newspapers. A copy of the inspection report is available, on request, at the home’s main reception desk or via the CSCI website. A vacancy has arisen for a registered home manager. Ringshill Nursing Home DS0000024297.V317720.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This summary also refers to other inspections carried out after the last key inspection of 16th May 2006 and before this second key inspection of Ringshill Nursing Home for 2006/7. Random Unannounced Inspection 17th May 2006 Due to serious concerns about fire safety of the home, following the inspection of 16th May 2006 a joint unannounced inspection was carried out with a Fire Safety Officer (FSO) on 17th May 2006. During this inspection it was noted that 3 immediate requirements made at the time of the inspection of 16th May 2006 had been met; no fire doors were wedged open with unapproved items or means; no fire doors were blocked and the unsafe courtyard had been cordoned off. The FSO found that the home had a number of fire safety issues and has since worked with the home to ensure that it is a safer place from the risk of fire. Random Unannounced Inspection 19th June 2006 On the 19th June 2006 an unannounced random inspection was carried out to assess compliance with the requirement that was carried forward from 16th May to 23rd May 2006. This requirement was associated with the standard of care provided to residents who were at risk of dehydration and development of pressure sores. The standard of care for these residents had improved and the home had met the requirement. During the inspection it was noted that fire doors were wedged open by unapproved methods. Following consultation with the FSO a further requirement was made by the Commission to ensure that the home was safe form the risk of fire. Random Unannounced Inspection 14th July 2006 On the 14th July 2006 an unannounced random inspection was carried out, firstly to assess if improvements that have been made had been sustained, with regards to health care and secondly to assess if action had been taken to comply with requirements following the random (pharmacist) inspection of 10th May 2006. Ringshill Nursing Home DS0000024297.V317720.R01.S.doc Version 5.2 Page 6 There was inadequate care provided for a resident who was assessed to have a high risk of pressure sore development and who had grade 4 pressure sores of the right and left hips. As a result of this serious concern an immediate requirement was made, since improvements that had been made, had not been sustained. There were a number of deficiencies in the safe storage of medicines and there were still some concerns over the accuracy and completeness of medication records. In addition no risk assessments were completed for those residents who self-medicate. Requirements made for action to be taken by 30th June 2006 had not been met and a new timescale of 14th July 2006 was made for all those requirements that had not been met with regards to medication. Random Unannounced Inspection 18th September 2006 On the 18th September 2006 an unannounced random inspection was carried out. The main purpose for this inspection was to assess what action had been made to comply with the requirements of the unannounced random inspection of 14th July 2006. During the inspection other standards were assessed also. It was noted that care plans were not always revised, or there were care plans on file that were no longer active. A requirement and recommendation were made about these findings. Evidence suggested that the standard of nursing care had improved and there was evidence to suggest that this care was beneficial to the residents’ health and welfare. Although the home had met an immediate requirement made at the time of the key inspection of 16th May 2006, to cordon off the courtyard area until this was safe to visit, it was noted that the work that had been carried out was not complete. Although people had visited this area it remained unsafe. As a result of this a requirement was made for the courtyard to be safe and accessible by May 2007. Although the inspection showed that there had been considerable improvements in the quality of medication records there were still some deficiencies and as a result of this inadequate standard of record keeping the requirement was carried forward with a new timescale for action. The storage of controlled drugs had improved but not to a wholly acceptable standard. Based on this evidence the requirement had been carried forward with a new timescale for action. A requirement associated with risk assessment for people who were selfmedicating had not been met and this requirement had been carried forward with a new timescale for action. Ringshill Nursing Home DS0000024297.V317720.R01.S.doc Version 5.2 Page 7 The requirements associated with staff adhere to the home’s medication policies and procedures and the safe storage and disposal of medication had been met. A recommendation was made about the method of recording temperatures of refrigerators that are used for the storage of medication. Random Unannounced Inspection 12th October 2006 The reason for this inspection was to assess if improvement had been sustained with particular regard to the health and welfare of residents and if any improvement had been made with regards to care plan documentation. There was evidence to suggest the home was providing appropriate care for people with complex nursing needs and improvements in this area had been sustained. However the home had received conflicting and confusing advice from general practitioners and specialist nurses and as a result of this a recommendation was made for the home to gain clearer guidance about the management of residents’ medical conditions. The requirement made following the inspection of 18th September 2006, with regards to care plan documentation. The requirement was carried forward with a new timescale for action. POVA and Multi-Agency Meetings Since April 2006 the home has been subject to a number of protection of vulnerable adult against abuse (POVA) meetings and multi-agency meetings with representatives from the Commission for Social Care Inspection, Local Council, Primary Care Trust and Four Seasons Health Care Limited. The purpose of the meetings was to openly discuss the concerns that agencies had about the standards of care provided by the home and what action people needed to take to improve these standards. It is acknowledged that Ringshill Nursing Home has had a turbulent and unsettled period for a number of months due to these issues, change of management of the home and the increased number of inspections and monitoring visits by representatives of the Local Council. Key Unannounced Inspection 1st November 2006 This is the 2nd key inspection for Ringshill Nursing Home for 2006/7. The inspection was unannounced and was carried out by three Inspectors between 10:15 and 14:30 and took 4.25 hours to complete. Ringshill Nursing Home DS0000024297.V317720.R01.S.doc Version 5.2 Page 8 At the time of the inspection there were 42 people living at the home and 5 of these were spoken to. A tour of the premises was made and staff, including the home manager, were also spoken to. Documentation was examined including pre-inspection information provided by the home. Included in this pre-inspection information were completed residents surveys. Eighty-seven of these surveys were sent out and 16 of these were returned. Ringshill Nursing Home currently provides an adequate standard of care as there is evidence that there has been an improvement in the standard of accommodation, care and support since the key inspection of May 2006. Such an improvement must be sustained and action must be taken to meet the requirements and recommendations of this report and any other requirements and recommendations made by other agencies. What the service does well: What has improved since the last inspection? The Commission has received a revised Statement of Purpose that includes all the required information. This requirement has been met. There has been no admission of any resident that the home is not registered for. This requirement has been met. Care records contained current information only. This recommendation has been considered. The summary part of this inspection report details what improvements have been made with regards to medication and standards of health care. There has been clear information obtained from health care professionals to guide staff in how to care for residents with diabetes. This recommendation has been considered. Medication storage and handling have considerably improved over previous inspections. Residents are given the choice of how they wish to live. This requirement has been met. Ringshill Nursing Home DS0000024297.V317720.R01.S.doc Version 5.2 Page 9 Four Seasons Health Care Limited have demonstrated an improved response in reporting allegations of abuse against service users, in line with local reporting procedures. This is a requirement that has been met. The guttering around the home was being cleared at the time of the inspection. This requirement has been met. The home has been redecorated and new carpets and furnishings have been provided. Hot water in baths and showers is being delivered at safe temperatures. This requirement has been met. Staff that are recruited are competent. This requirement has been met. Staff training programmes have been developed. This recommendation has been considered. There is an appointed permanent home manager. Existing quality assurance systems are being developed. This recommendation has been considered. Checks of temperatures of refrigerators and freezers in the kitchen are being recorded. This recommendation has been considered. The home has received a satisfactory fire inspection report. What they could do better: A requirement was made for care plans to guide staff in how to meet the assessed and changing needs of residents. This requirement has not been met and has been carried forward. Five requirements have been made about medication that include recording and administration practices. A requirement has been made for the dignity of residents to be respected at all times. A requirement has been made for a survey to be carried out to find out what all residents would like to do with regards to activities. Ringshill Nursing Home DS0000024297.V317720.R01.S.doc Version 5.2 Page 10 A recommendation has been made for a review of the standard of food and this review to be carried out in consultation with residents. A recommendation remains for communication between kitchen and care staff to be improved upon with particular regard about residents with unintentional weight loss. A requirement has been made for the courtyard to be made safe and accessible by May 2007. A recommendation remains for the home to have 50 of care staff with NVQ in care, or equivalent. An immediate requirements been made for full and satisfactory information to be obtained before staff work at the home. The home should have a manager who is registered with the Commission for Social Care Inspection. A recommendation has been made about this. Emergency lighting checks must be carried out according to the Four Seasons’ Health Care Limited policy. A requirement has been carried out about this. The names of people in attendance at fire drills should be recorded. A recommendation has been made about this. A requirement has not been met as not all staff have attended training in fire safety. This requirement has been carried forward. 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. Ringshill Nursing Home DS0000024297.V317720.R01.S.doc Version 5.2 Page 11 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 Ringshill Nursing Home DS0000024297.V317720.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 & 4 There is a good standard of information for prospective residents to enable them to make a choice of where to live. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A requirement was made following the inspection of 16th May 2006 for the Commission to receive a revised Statement of Purpose. This has been received and was satisfactory. This requirement has been met. A requirement was made following the inspection of 16th May 2006 for the home not to admit people that the home was not registered for. There has been one resident admitted to the home since the inspection of 16th May 2006. Ringshill Nursing Home DS0000024297.V317720.R01.S.doc Version 5.2 Page 13 Information provided by the home to the Commission, before the inspection, indicated that this person was admitted within the categories and conditions of registration. This requirement has been met. No other resident has been admitted to the home although examination of care files indicated that full assessments of the residents’ needs had been carried out by care managers prior to the residents moving into the home. Ringshill Nursing Home DS0000024297.V317720.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 & 10 The standard of health care is adequate and is to be improved upon. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A requirement was made, following the random inspection of 18th September 2006, for care plans to contain guidance for staff in how to meet the assessed, and changing, needs of the service user. During the random inspection of 12th October 2006 it was considered that this requirement had not been met; this was carried forward and a new timescale for action was made for 1st November 2006. Care files that were examined suggested that there had been some improvement in the standard of record keeping although the requirement has not been met in full. Care files that were examined suggested that there had been some improvement in the standard of record keeping although the Ringshill Nursing Home DS0000024297.V317720.R01.S.doc Version 5.2 Page 15 requirement has not been met in full. Where medication is prescribed for use on a “when required” basis, there are not always guidelines for staff to follow to ensure they are used appropriately, medication is not misused and to safeguard service users. A recommendation was made following the inspection of 18th September 2006 for care records to provide only current information and guidance about residents’ assessed needs. During the following random inspection of 12th October 2006 previous care plans were still contained in the working files. As a result of this finding this recommendation remained. During this key inspection it was noted that the care files that were examined contained current information only. As a result of this finding this recommendation has been considered. From 10th May 2006 and during the 1st key inspection and the subsequent random inspections (as detailed in the summary of this report) the standards of health care provided have been consistently assessed, by the Commission for Social Care Inspection and regulatory activity, including issuing an immediate requirement at the random inspection of 14th July 2006, has been carried out. It was noted during the last random inspection of 12th October 2006 that the home had sustained improvements in this area, although a recommendation was made to ensure that the advice provided by health care professionals was clear and void of any confusion. During this key inspection examination of care records indicated that this recommendation had been considered as there was clear and concise information provided by the general practitioner to guide staff in caring for residents with complex health conditions. 73.1 of respondents of the service user’s survey considered that they always received medical support that they needed; 26.9 of respondents of the service user’s survey considered that they usually received medical support that they needed. Medication storage and handling have considerably improved over previous inspections. All storage areas were secure and their temperatures monitored and recorded on a regular basis. The temperatures of the refrigerators used for the storage of medicines are also recorded using a maximum/minimum thermometer as recommended on previous inspections. However, it is of concern that the temperature of the refrigerator on the ground floor had been recorded above the recommended maximum of 8οC without any action taken to investigate if the quality of medicines stored there has been compromised. This is also not in line with the home’s own policy and procedures. Ringshill Nursing Home DS0000024297.V317720.R01.S.doc Version 5.2 Page 16 Medication records have improved but there are few worrying examples where medication is not being administered as prescribed. For example where medication is prescribed to be taken regularly, staff are administering on a discretionary basis. There is a need to ensure that medication is prescribed to reflect the service user’s needs and is administered in accordance with the prescriber’s instructions. Records of the receipt, administration and disposal of medicines are of a good standard and provide a good audit trail of medicines usage. Where residents self medicate there is not always a risk assessment and risk management framework in place. Storage of controlled drugs has improved and now meets regulatory standards. However, there is still a need to record the full name and address of the supplier in the controlled drugs register when controlled drugs are received, and also to indicate the name and address of the recipient when they are disposed of. Residents that were spoken to were complimentary about staff and considered that they were good and kind. However during the inspection it was noted that residents were wearing disposable tabards; a resident’s care record had an entry of the word “bum” and a member of staff, in responding to an urgent situation said,”Oh crap”. As a result of these findings a requirement has been met for staff to respect residents’ dignity all times. Ringshill Nursing Home DS0000024297.V317720.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 &15 The quality of residents’ life is adequate but could be improved upon. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Commission has received written comments about activities in the home, “ (My mother) sits for hours alone and nothing to occupy her” and “ I would like to see more activities…”. 37.5 of respondents of the service user’s survey considered that they can always take part in the activities that are arranged by the home; 43.75 of respondents of the service user’s survey considered that they can usually take part in the activities that are arranged by the home; 18.75 of respondents of the service user’s survey considered that they can never take part in the activities that are arranged by the home. Discussion with the Manager and examination of residents’ surveys suggested that residents, mainly living of the ground floor of the home, had been consulted about activities although consultation of residents living on the first Ringshill Nursing Home DS0000024297.V317720.R01.S.doc Version 5.2 Page 18 floor of the home had generally not been consulted. A requirement has been made for a survey to be carried out to gain the views of all residents about what they would like to do as regards to activities. A requirement was made following the inspection of 16th May 2006 to ensure that residents were given the choice of how to live. Discussion with residents suggested that this requirement has generally been met. Residents spoken to said that they received guests and that they were able to visit relatives. Copies of menus were submitted to the Commission before the inspection. These menus detail a range and choice of food, including the option of a cooked breakfast each morning. A recommendation was made, following the inspection of 16th May 2006, for ways to improve communication between care staff and kitchen staff with particular regard to the dietary needs of residents with unintentional weight loss. Discussion with kitchen staff, care staff and examination of care files of residents with unintentional weight loss indicated that there is limited communication between the kitchen staff and care staff. As a result of this evidence this requirement remains. 25 of respondents of the service users survey considered they always liked the meals; 43.75 of respondents of the service users survey considered they usually liked the meals; 25 of respondents of the service users survey considered they sometimes liked the meals; 6.25 of respondents of the service users survey considered they never liked the meals. Those residents that were spoken to at the time of the inspection were satisfied with the standard of meals although one resident considered that the range of food offered for tea time was somewhat limited in choice. Residents’ written comments ranged from the meals being very good to comments requesting more salads during the warmer weather and vegetables being too “wet”. During the visit to the kitchen (two hours before the lunch was being served) it was noted that vegetables were simmering on the stove. Staff confirmed that the vegetables had been simmering for 20 minutes before the Inspectors’ visit to the kitchen. A recommendation has been made for a review of the standard and choice of food provided and this review should be also in consultation with residents. Ringshill Nursing Home DS0000024297.V317720.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16& 18 There are good systems in place for responding to concerns, complaints and allegations. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information provided by the home manager prior to this key inspection notes that the home has received 9 complaints between July 2005 and July 2006. Two of these 9 complaints were substantiated and 3 of these 9 complaints were partially substantiated. The same information notes that all the 9 complaints had been responded to within a 28-day period. The record of complaints was examined and this was satisfactory. Response times were within 28 days and there was no recurring element to the complaints, other than those investigated under the adult protection procedures (as duly reported in the inspection report of the inspection of 16th May 2006). 62.5 of respondents from the service user’s survey considered that they always knew who to speak to if they were not happy; 31.25 of respondents from the service user’s survey considered that they usually knew who to speak to if they were not happy; 6.25 of respondents from the service user’s Ringshill Nursing Home DS0000024297.V317720.R01.S.doc Version 5.2 Page 20 survey considered that they sometimes knew who to speak to if they were not happy. 62.5 of respondents from the service user’s survey always knew how to make a complaint; 12.5 of respondents from the service user’s survey usually knew how to make a complaint; 6.25 of respondents from the service user’s survey did not know how to make a complaint; the remaining respondents did not complete this section of the survey. The Manager reported that information about the home, including how to make a complaint, was sent to representatives of residents in October 2006. The home has been subject to a number of POVA investigations and a requirement was made following the key inspection in May 2006 to ensure residents were protected from abuse. This requirement was made, due to the failings of reporting of abuse by the home, during 2006. Since this requirement was made the home has followed correct local reporting procedures following allegations of abuse against a resident. As a result of this action it is considered that this requirement has been met. Ringshill Nursing Home DS0000024297.V317720.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 25 &26 The standard of maintenance of the home is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the first key inspection of 16th May 2006 the home has been redecorated and new carpets have been provided. Information provided by the home manager indicates that arrangements have been made for new baths and new showers to be fitted and new toilets are to be replaced where need. Following this first key inspection remedial work was carried out on the internal courtyard. However during the random inspection of 18th September 2006 it was noted that although some work had been carried out this was insufficient to ensure the courtyard was safe to visit. The surface remained uneven and there were broken paving slabs. In addition a concrete ramp was not provided Ringshill Nursing Home DS0000024297.V317720.R01.S.doc Version 5.2 Page 22 with safety rails and the gradient of the ramp posed a risk to the safety of people requiring the assistance of a wheelchair. As a result of these findings the courtyard was decommissioned and a requirement was made for this area to be made safe and accessible by May 2007. It was also noted that some areas of external walls, that faced into the courtyard, were covered in moss due to damp and that the overhead guttering was blocked with debris. A requirement was made for action to be taken to ensure that these areas were properly maintained. At the time of the inspection gutters were being cleared of debris. This requirement has been met. A requirement was made following the inspection of 16th May 2006 to ensure that the temperatures of hot water accessed by residents did not exceed 43 degrees centigrade. Records of temperatures of hot water checks were satisfactory. This requirement has been met. 68.75 of respondents of the service user’s survey considered that the home was always fresh and clean; 25 of respondents of the service user’s survey considered that the home was usually fresh and clean; 6.25 of respondents of the service user’s survey considered that the home was sometimes fresh and clean. At the time of the inspection the home was clean and fresh. Ringshill Nursing Home DS0000024297.V317720.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 &30 Staff training and recruitment is adequate and is to be improved upon. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Following the inspection of 16th May 2006 a requirement was made to ensure that staff recruited to work at the home were competent to do so. This requirement was based on evidence provided by health and social care professionals with particular regard to the staff caring for residents assessed to have nursing needs. Following random inspections of the home between the two key inspections the standard of health care has improved and staff are attending training in specialist health care matters. As a result of this evidence this requirement has been met. Following the key inspection of 16th May 2006 a recommendation was made for the home to have a minimum of 50 care staff with NVQ level 2 in care. The home currently employs 32 care staff. According to the Manager 4 of these staff have NVQ level 2 in care i.e. 12.5 . As a result of this of staff with NVQ level 2 this recommendation remains. Ringshill Nursing Home DS0000024297.V317720.R01.S.doc Version 5.2 Page 24 A requirement was made, following the inspection of 16th May 2006, for full and satisfactory information to be obtained about staff before they started working at the home. Examination of 3 staff files was carried out. For two of the 3 files there were discrepancies between dates of employment on application forms and information provided by referees with regards to dates of previous employment. For one of the files there was a gap in employment history of 2 years. None of these files provided a written explanation about the gaps in employment history and there was no recorded evidence to suggest that discrepancies of dates (as detailed in documentation) were explored. In addition there was no confirmation with the Nursing and Midwifery Council that the registration of the nurse was current and satisfactory. An immediate requirement has been made about these findings. Information provided by the home manager before the inspection notes that training has been arranged, and attended by some staff, in the following areas: wound care, infection control and care planning. Examination of staff training records and discussion with staff confirmed that they had attended training in infection control, care of residents with continence issues, catheter care and taking specimens of bloods from residents. Following the inspection of 16th May 2006, a recommendation was made for the existing training programme for staff to be developed. Examination of the Manager’s training matrix indicated that this recommendation has been considered. Ringshill Nursing Home DS0000024297.V317720.R01.S.doc Version 5.2 Page 25 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 & 38 The management of the home is adequate and is to be improved upon. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the key inspection of 16th May 2006 Four Seasons Health Care Limited has appointed a permanent home manager. She is a registered nurse who has previous experience of working and managing a care home. In June 2006 the Commission received a written comment that states, “Over the past few weeks, under the new management things look as though improvements are slowly being made.” During the inspection staff made Ringshill Nursing Home DS0000024297.V317720.R01.S.doc Version 5.2 Page 26 positive comments about the Manager and considered that Ringshill Nursing Home was a happier place for people to live in and work at. A recommendation was made, following the inspection of 16th May 2006 for the home to have a registered manager. An application to register the current home manager has been received although, to date, the Commission is awaiting information before the application can be considered. Until such an application has been approved this recommendation remains. A recommendation was made, following the inspection of 16th May 2006, for existing quality assurance systems to be developed, as no survey has been carried out to seek the views of residents, or their representatives. This recommendation has been considered, in part, as the manager has sought views if residents about food and activities. (See also Standard 12 of this report). The Commission receives copies of regulation 26 reports and copies of weekly audits carried out by the home manager have been received on request. These audits include the number of residents with pressure sores and care plan documentation. Examination of residents’ care records indicated that these had been subject to an internal audit. Discussion with staff and examination of records and balances of residents’ personal monies indicated that the home operates a satisfactory system for the safe keeping of residents’ personal monies. Two immediate requirements were made at the time of the inspection of 16th May 2006 with regards to fire safety. A follow-up inspection with the FSO on 17th May 206 indicated that these requirements had been met, although during a random inspection of 19th June 2006 there was another breach of the same regulation and a requirement was made. Since this inspection there have been no further breaches of this regulation. A copy of the fire inspection report for July 2006 was seen and this was satisfactory. A requirement was made for all staff to attend training in fire safety matters. Discussions with staff and examination of fire training records indicated that not all staff have attended fire training. This requirement has not been met and has been carried forward with a new timescale for action. A recommendation was made for the home to demonstrate that records of temperatures of kitchen refrigerators and freezers had been carried out. During the visit to the kitchens records were seen for checks of temperatures of refrigerators and freezers. This recommendation has been considered. Fire alarm checks were satisfactory. Checks for emergency lighting had not been recorded since May 2006 and as a result of this insufficient evidence a requirement has been made. Ringshill Nursing Home DS0000024297.V317720.R01.S.doc Version 5.2 Page 27 Records of staff attending fire drills were seen although not all names of people in attendance were recorded. A recommendation has been made about this. Ringshill Nursing Home DS0000024297.V317720.R01.S.doc Version 5.2 Page 28 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 x 3 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 1 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 x x x x x 3 3 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 3 x 3 x x 2 Ringshill Nursing Home DS0000024297.V317720.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? YES 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 Requirement The Registered Person must ensure that the care plan provides guidance for staff in how to meet the assessed, and changing, needs of the service user. Timescale of 27/09/06 not met. Requirement carried forward with new timescale for action. The Registered Person must ensure that medicines controlled under the Misuse of Drugs Act 1971 are recorded in accordance with the Act and associated Regulations. This is a repeat requirement. Previous timescales of 30/06/06, 14/07/06 and 1/11/06 not met 3. OP9 13(2) 01/12/06 The Registered Person must ensure that there is a documented risk assessment and risk management procedure for those resident’s who selfmedicate. This is a repeat requirement. Ringshill Nursing Home DS0000024297.V317720.R01.S.doc Version 5.2 Page 30 Timescale for action 15/12/06 2. OP9 13(2) 01/12/06 Previous timescales of 30/06/06, 14/07/06 and 1/11/06 not met 4. OP9 12(1) 13(2) The Registered Person must ensure that medicines are only administered in accordance with the prescriber’s instructions. The Registered Person must ensure that records of medicines prescribed are accurate and up to date. The Registered Person must ensure that staff adhere to the home’s own policy and procedures for the safe handling of medicines. The Registered Person must ensure that the dignity of service users is respected at all times The Registered Person must consult service users about what activities they would like to be provided in the home. The Registered Person must ensure that the courtyard is safe for people to visit The Registered Person must ensure that full and satisfactory information is obtained about staff before they work at the home. The Registered Person must ensure emergency light checks are carried out according to company policy The Registered person must ensure that all staff attend training in fire safety matters. Timescale of 01/07/06 not met. Requirement carried forward with new timescale for action. 01/12/06 5. OP9 12(1) 13(2) 01/12/06 6. OP9 13(2) 01/12/06 7. 8. OP10 OP12 12(4)(a) 16(2)(n) 08/11/06 31/01/07 9. OP19 23(2)(b) 01/05/07 10. OP29 19 & Schedule 2 23(4)(c) (iv) 23(4)(d) 01/11/06 11. OP38 08/11/06 12. OP38 15/12/06 Ringshill Nursing Home DS0000024297.V317720.R01.S.doc Version 5.2 Page 31 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 2 Refer to Standard OP15 OP15 Good Practice Recommendations The Registered Person should consider carrying out a review on the standard of food provided and this review to be in consultation with service users. The Registered Person should consider ways to improve communication between care staff and kitchen staff with particular regard to dietary needs of service users with unintentional weight loss. 3 4 5 OP28 OP31 OP38 The home should have 50 care staff with NVQ level 2 or equivalent. The home should be managed by a registered person. The names of people attending fire drills should be recorded. Ringshill Nursing Home DS0000024297.V317720.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Cambridgeshire & Peterborough Area Office CPC1 Capital Park Fulbourn Cambridge CB21 5XE 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 Ringshill Nursing Home DS0000024297.V317720.R01.S.doc Version 5.2 Page 33 - 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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