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Inspection on 16/05/06 for Ringshill Nursing Home

Also see our care home review for Ringshill Nursing Home for more information

This inspection was carried out on 16th May 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

What has improved since the last inspection?

What the care home could do better:

CARE HOMES FOR OLDER PEOPLE Ringshill Nursing Home Sallowbush Road Huntingdon Cambridgeshire PE29 7AE Lead Inspector Elaine Boismier Unannounced Inspection 16th May 2006 9:50 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.V292338.R01.S.doc Version 5.1 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.V292338.R01.S.doc Version 5.1 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 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.V292338.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. No more than 61 nursing care beds Date of last inspection 25th January 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 £341 to £540. 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 manager. Ringshill Nursing Home DS0000024297.V292338.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This summary includes also reference to multi-agency meetings, held during January and April 2006. These multi-agency meetings were held under the local adult protection procedures. It has been concluded that the home had failed to provide adequate care for residents assessed to have nursing needs. This summary, and report, also includes reference to an unannounced random inspection carried out on 10th May 2006. The purpose of the random inspection was to assess the home’s standard of care provided for residents assessed to be at risk, or who have developed, pressure sores. There were two requirements made following this random inspection. Evidence suggested that there was a failure to provide adequate care for residents assessed to be at high risk of pressure sore development. Evidence also suggested that there was a delay for gaining specialist advice for residents who had developed pressure sores. A pharmacist inspection was also carried out on 10th May 2006. The report, following this specialist inspection is yet to be made available. However there is reference to some of the findings of this pharmacist inspection, although any requirements and recommendations made will be included in the aforementioned separate pharmacist inspection report. This is the first key inspection of Ringshill Nursing Home for 2006/7. The inspection was unannounced and carried out by two Inspectors between 9:50 and 16:30 and took 6.75 hours to complete. Between 10th May and 16th May 2006 twenty-six Inspector hours have been spent at the care home. At the time of this inspection, of 16th May 2006, there were 53 residents at the home of which 29 had been assessed to have nursing needs. A tour of the building was made a number of residents, visitors and staff, including the Acting Manager, were spoken to. Documentation was seen and information provided by external agencies, by the home prior to this inspection and during the random inspection of 10th May 2006, has been considered. Ringshill Nursing Home provides adequate care for people assessed to have personal care needs only but provides a poor service for people who have been assessed to have nursing needs. This is due to poor staff recruitment practices, poor staff training and poor management of the home. Although the home aims to provide a homely, caring and friendly place to live in, it is currently an unsafe place, unless the Registered Provider takes action Ringshill Nursing Home DS0000024297.V292338.R01.S.doc Version 5.1 Page 6 to meet the requirements, and considers the recommendations, of this inspection report, and any other requirements and recommendations made by external agencies. Since August 2005 the home has not had a permanent registered manager in place. Although the home has been managed by the Company there has been significant failings that have resulted in a number of multi-agency meetings, held under the local reporting procedures for the protection of vulnerable people against abuse (POVA). Although the home has been given the opportunity to improve, following the POVA meeting in January 2006, any improvement made has not been sustained, resulting in further POVA meetings held in April 2006. Following these POVA meetings in April 2006 the home has provided an increase in training of staff, including care staff and ancillary staff. Positive comments were made, by the staff to the Inspectors, about the change of management of the home. Staff , considered that the home was “moving in the right direction”. What the service does well: The home does well in the following areas: • During the inspection of 10th May 2006 a resident said that Ringshill Nursing Home was a lovely place to live and that they were very happy living there. This was confirmed also by residents and visitors during this inspection. Residents are looked after by kind and caring staff. Residents said that the food was lovely, “couldn’t be better”. A refurbishment programme is in place to improve the environment of the home to become more homely and comfortable for residents to live in. The courtyard has colourful hanging baskets, a water feature and garden furniture for residents and their guests to enjoy. • • • • What has improved since the last inspection? Following the last inspection of January 2006 there were 4 requirements made and 2 requirements made following the random inspection of 10th May 2006. Four of these 6 requirements have been met. • Following the inspection of January 2006 a requirement was made to ensure that any doors that have had closers removed must have them DS0000024297.V292338.R01.S.doc Version 5.1 Page 7 Ringshill Nursing Home replaced. An assessment of all room doors was needed to ensure they all close on their rebate. Timescale for action was 5th March 2006. Action has been taken to meet this requirement. • Following the inspection of January 2006 a requirement was made to ensure that all areas of the home were free from unpleasant odours and that staff were trained appropriately to deal with this. Timescale for action was 5th March 2006. This requirement has been met. Following the inspection of January 2006 a requirement was made for the CSCI to be notified about the appointment of a home manager and an application be made to CSCI for this person to be registered. Although the timescale for action was by 20th March 2006, action has been taken to appoint a person to this vacant position. As a result of this action, this requirement has been met. Following the inspection of January 2006 a requirement was made to ensure that the health and safety of service users and staff was to be safe guarded at all times, to include regular checks on door closers. Timescale for action was 5th March 2006. This requirement has been met. Staff are attending training to become competent in the jobs that they do. • • • What they could do better: The home could improve in the following areas: • • The Statement of Purpose must be revised and a copy of this to be submitted to the Commission. A requirement has been made about this. The home must not admit people that that the home is not registered for, unless an application, to vary the registration of the home, has been approved by the Commission. A requirement has been made about this. A requirement was made following the inspection of 10th May 2006 to ensure that the health and welfare of residents was provided for. Timescale for action was 16th May 2006. This requirement has not been met and has been carried forward with a new timescale for action. A requirement was made following the inspection of 10th May 2006 to ensure that residents received treatment and advice from other health care professionals in a timely manner. Timescale for action was 16th May 2006. This requirement has not been met and has been carried forward with a new timescale for action. DS0000024297.V292338.R01.S.doc Version 5.1 Page 8 • • Ringshill Nursing Home • • • • Residents must be offered a choice of how they wish to live. A requirement has been made about this. A recommendation has been made for communication to be improved upon between care staff and kitchen staff. Residents must be protected from abuse. A requirement has been made about this. The surface of the internal courtyard must be made safe. An immediate requirement has been made to reduce the risk of harm and a requirement has been made for action to be completed by 16th July 2006. Appropriate action must be taken when hot water temperatures are recorded above 43 degrees centigrade. A requirement has been made about this. Staff must be competent to work at the care home. A requirement has been made about this. The home should have 50 of care staff with NVQ level 2 qualification, or equivalent, working at the home. A recommendation has been made about this. The home must obtain all required information prior to staff commencing work at the care home. A requirement has been about this. The home should continue to develop the current training programme to ensure that all staff are competent in carrying out their duties. A recommendation has been about this. The home should be managed by a registered manager. A recommendation has been made about this. Existing quality assurance systems should be improved upon. A recommendation has been made about this. Existing records of temperatures of kitchen fridges and freezers should be kept up to date. A recommendation has been made about this. Fire exits must be kept clear at all times. An immediate requirement has been about this. Doors must not be held open, other than by means approved by the fire safety officer. An immediate requirement has bee made about this. All staff must attend training in fire safety matters. A requirement has been made about this. DS0000024297.V292338.R01.S.doc Version 5.1 Page 9 • • • • • • • • • • • Ringshill Nursing Home 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. Ringshill Nursing Home DS0000024297.V292338.R01.S.doc Version 5.1 Page 10 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.V292338.R01.S.doc Version 5.1 Page 11 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): 1,3,4 & 6 Information for, and about, prospective residents is poor in some areas and adequate in other areas. There is poor compliance with the Care Standards Act 2000. EVIDENCE: A copy of the current Statement of Purpose was provided during the inspection of 10th May 2006. Subsequent examination of this has been carried out and evidence suggests that the information is not in date e.g. documentation has a date for 2003. In addition information in the documentation is considered misleading as there are details of categories of registration, including those for children’s services, that are not applicable to Ringshill Nursing Home. A requirement has been made for the Statement of Purpose to be revised and a copy of this to be submitted to the Commission. Examination of residents’ care records indicated that pre-admission assessments information is received by the home prior to, or on the day, when the resident moves in. Ringshill Nursing Home DS0000024297.V292338.R01.S.doc Version 5.1 Page 12 The home is registered as a care home with nursing. However information provided at a multi-agency meeting, and during the inspection of 10th May 2006, indicates that the home has admitted individuals assessed to have mental health needs. Examination of a resident’s care records, during this inspection, also indicated also that people have been admitted the care home that Ringshill Nursing home is not registered for. As such this action is an offence against Section 24 of the Care Standards Act 2000. A requirement has been made. The home provides a service called “Interim Care” although information provided to the Commission, prior to this inspection, indicates that intermediate care might have been also provided at the home. According to the Acting Manager it is not the intention of the Company to provide intermediate care. This Standard, Standard 6 has not been formally assessed on this occasion. Ringshill Nursing Home DS0000024297.V292338.R01.S.doc Version 5.1 Page 13 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): 7,8,9 &10 The standard of nursing care is poor although residents are looked after by kind and caring staff. EVIDENCE: During both inspections of 10th May 2006 care plans that were seen indicated that there had been a review of this documentation to improve the standard of information (See also Standard 33 of this report). During the inspection of 10th May 2006 a brief examination was carried out of the care records for people living on the ground floor. Evidence suggests that these records provided adequate details about the resident and about their needs. During this inspection of 16th May 2006 care records examined were those of residents living on the first floor of the home. Care records remain adequate to provide sufficient detail and guidance about the residents’ needs. Ringshill Nursing Home DS0000024297.V292338.R01.S.doc Version 5.1 Page 14 The Commission has received two notifications about untoward incidents occurring in the home during May 2006. Examination of the care records, relating to these specific incidents, was carried out and evidence suggests that risk assessments were revised following these untoward incidents. During April 2006 the Commission attended multi-agency meetings held under the local adult protection reporting procedures. As a result of this information, and also information provided in January 2006 by members of the POVA team, on 10th May 2006 a random unannounced inspection was carried out to assess the standard of care provided to residents assessed to be at risk of pressure sores. This inspection also included an assessment of the standard of care provided for those residents who had acquired pressures sores., the majority of which residents had acquired whilst living at Ringshill Nursing Home. As a result of the findings 2 requirements were made as the home had not provided adequate care and had delayed in referring residents for specialist advice in how to treat these deteriorating pressure sores. The timescale for action was by 16th May 2006 for both of these requirements. (see also Standard 27 of this report). During the random inspection of 10th May 2006 examination was carried out of 3 residents’ care records. Of the 3 residents it was noted that the person was at risk of dehydration. The care plan guidance for staff stated that the resident should take between 2 to 3 litres of drink every 24 hours. During the 24-hour period of 9th May 2006 the resident had taken 640 mls of drink. During this inspection the care records of the same resident were examined again. For the previous 24 hours the resident had drunk again less than 1 litre of drink. During the visit to the resident’s bedroom the person was asleep, holding a cold drink in their hand and had been left unsupervised. There was no change in the resident’s care records to suggest that action had been taken in response to the findings of 10th May 2006. The risk of dehydration of the resident remains. During this inspection it was noted that the home had failed to provide adequate care for a person assessed to be at a high risk of developing pressure sores. There was insufficient evidence to suggest that care practices had changed to reduce the resident’s risk of developing a pressure sore. The requirement for the home to ensure that residents health and welfare needs are met remains, as the timescale for action to be taken by 16th May 2006 has not been met. This requirement has been carried forward and a new timescale made. Ringshill Nursing Home DS0000024297.V292338.R01.S.doc Version 5.1 Page 15 During this inspection, of 16th May 2006, examination of residents’ care records was carried out to assess compliance with a requirement made following the random inspection of 10th May 2006. Although there was evidence that GP visits had been made and a speech and language therapist had been consulted there was insufficient evidence to suggest what action had been taken , in consulting outside agencies, for residents with significant and unintentional weight loss. (See also Standard 15 of this report). The requirement made following the random inspection of 10th May 2006 for residents to receive treatment and advice from other care professionals, in a timely manner, remains, as the timescale for action to be taken by 16th May 2006 has not been met. This requirement has been carried forward and a new timescale made. On 10th May 2006 an unannounced pharmacist inspection was carried out. Findings indicated that storage and record keeping of medication must be improved upon. These, and other findings, including any requirements and recommendations will be made in a separate inspection report, and will be referred to in the next inspection report of the care home. During both inspections of May 2006 residents expressed their very positive views about what it was like living at Ringshill Nursing Home and these positive views were reinforced by guests visiting the home. Residents considerd that staff were kind and caring. It was noted that staff knocked on residents’ doors before entering and spoke to the residents in a respectful well. Ringshill Nursing Home DS0000024297.V292338.R01.S.doc Version 5.1 Page 16 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): 12,13,14 &15 Residents live an adequate quality of life that could be improved upon. EVIDENCE: During the random inspection of 10th May 2006 it was noted that some residents were engaged in a bible and hymn singing session and that residents were preparing for a game of bingo during this inspection. Although it was noted, during the random inspection of 10th May 2006 , staff offered no choice to a resident about their personal care. Discussion with residents during this inspection indicated that no choice was offered for when the resident would like to have a wash/shower/bath. A resident said that they would prefer to have a bath every day but this option was not available. A requirement has been made about this. Residents stated that they were able to receive their guests at any time and this was also confirmed by visitors to the home. Staff stated that the home keeps personal monies for some, but not all residents, for safe-keeping, as a matter of choice. During the tour of the premises it was noted that bedrooms were furnished with items of a personal nature such as pictures and ornaments. Ringshill Nursing Home DS0000024297.V292338.R01.S.doc Version 5.1 Page 17 Residents said that the food was lovely, “couldn’t be better”. A copy of the daily menu was available outside the ground floor dining room that provided details of a choice of menu. Staff stated that residents’ choice of what they would like to eat is obtained the day before and this information is provided to the kitchen staff. Discussion with kitchen staff indicated that systems in place are patchy when care staff request additional nutritional supplements, or fortified foods, for residents with unintentional weight loss. (See also Standard 8 of this report). A recommendation has been made about this. Ringshill Nursing Home DS0000024297.V292338.R01.S.doc Version 5.1 Page 18 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): 16 & 18 Residents have access to a good complaints system. There is a history of poor reporting of abuse. EVIDENCE: The record of response to complaints was seen and this was satisfactory. Residents said that they knew who to speak to if they were unhappy about something, although none of these residents had any concerns, or complaints, about the standard of care provided by the home. During January 2006 and April 2006 the home has been subject to a number of POVA meetings due to residents acquiring pressure sores whilst living at the home. The individual allegations, or suspicion of abuse, were reported by external agencies, rather than by the home or representatives of the registered provider. Discussion with staff indicated that, following recent training in POVA issues , staff have an increased awareness about what to do in the event of allegations, or suspicions, of abuse. However, a requirement has been made, due to the failings of reporting of abuse by the home, during 2006. During the random inspection of 10th May 2006 the Acting Manager stated that the home did not have a copy of the local reporting procedures for staff to be guided in what to do in the event of any allegation, or suspicion, of abuse. During this inspection she reported that she is taking action to obtain a copy of this guidance. Ringshill Nursing Home DS0000024297.V292338.R01.S.doc Version 5.1 Page 19 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): 19,25 & 26 The environment of the home is adequate and being improved upon although safety standards of the home are sometimes poor. EVIDENCE: According to the Acting Manager, a refurbishment programme is in place to improve the environment of the home to become more homely and comfortable for residents to live in. This includes redecoration of bedrooms and corridors and replacing stained carpets. Communal seating areas, provided on the lower floor, have recently been refurbished to provide a homely feel. Residents, and their guests, expressed their enjoyment about these newly refurbished areas. The enclosed courtyard is located on the ground floor and has hanging baskets, garden furniture and a water feature The courtyard is the only area provided for residents and their guests to sit outside and those spoken to confirmed that this area is visited by them during periods of warmer weather. Ringshill Nursing Home DS0000024297.V292338.R01.S.doc Version 5.1 Page 20 During the inspection of 10th May 2006, it was noted that the surface of the courtyard was uneven and that there were paving slabs that were unsafe. The Acting Manager reported that the internal courtyard has not been visited by residents, or their guests, this year although action would be taken to make sure that the courtyard was safe for residents and visitors to access. During this inspection the action taken to ensure that the unsafe paving slabs were safe was inadequate. Further examination of the courtyard indicated that the surface has a number of dips and broken concrete and paving slabs. Residents and their guests confirmed that they enjoy sitting in the courtyard when the weather is warm enough to do so. An immediate requirement has been made to ensure that the area is safe and a requirement has been made for this area to be maintained. Following the inspection of January 2006 a requirement was made to ensure that any doors that have had closers removed must have them replaced. An assessment of all room doors was needed to ensure they all close on their rebate. Timescale for action was 5th March 2006. Examination of maintenance records indicated that action has been taken and this requirement has been met. Records of hot water temperature checks were examined for April 2006. Not all the records had been completed. It was also noted that no action had been taken, in response to a temperature record of above 60 degrees centigrade, of hot water from a bath tap. A requirement has been made about this. (The temperature of this hot water was checked by the Inspectors and found to be between 41 and 42 degrees centigrade). Information provided at a POVA meeting held during April 2006 indicated that there was poor infection control in the home. Information provided by staff, and on display on staff information notice boards, indicates that arrangements are in place for staff to attend training in infection control. ( See also Standards 27 and 30 of this report). Following the inspection of January 2006 a requirement was made to ensure that all areas of the home were free from unpleasant odours and that staff were trained appropriately to deal with this. Timescale for action was 5th March 2006. On the day of the inspection the home was generally clean and there were no offensive odours. During the tour of the building it was noted that some carpets were in the process of being shampooed. This requirement has been met. Ringshill Nursing Home DS0000024297.V292338.R01.S.doc Version 5.1 Page 21 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): 27,28,29 &30 Staff recruitment procedures and staff competencies are poor. Staff training has been poor, although is improving. EVIDENCE: According to the Acting Manager the home has appointed staff, on a permanent, or temporary, basis and agency staff are used for unplanned for staff absence to include sick leave. During this inspection staff were sufficient in numbers and were carrying out their duties in an unhurried manner. Staff considerd that team working in the home had recently improved and those staff spoken to felt satisfied with their work (See also Standard 31 of this report). During the random inspection, of 10th May 2006, discussion was made with a health care professional who was visiting the home at the time of the inspection. Information provided by this person indicated that currently registered nurses, employed at the home, were not sufficiently skilled in assessing complex and changing needs of those residents assessed too have nursing needs. This view was also shared by representatives of Four Seasons Health Care during POVA meetings held during April 2006 and during the random inspection of 10th May 2006. Ringshill Nursing Home DS0000024297.V292338.R01.S.doc Version 5.1 Page 22 Discussion with care staff, during this inspection, indicated that they felt that they had been unable to provide adequate care for residents with nursing needs. A requirement has been made about this. (See also Standards 29 &30 of this report). The home has 29 care staff. Four of these staff have NVQ level 2 or equivalent i.e. less than 50 . A recommendation has been made about this. Three staff files were examined to assess the home’s recruitment procedures. There was insufficient (required) information in 2 of the 3 files. This information included 1 written reference that was received after the member of staff had commenced duties at the home; no 2nd written reference was available. For another member of staff there was no application form to provide information about the person’s employment history and no documentary evidence that this person has been checked against the POVA and CRB records. There was also insufficient information to suggest that staff, including nursing staff, had previous experience in caring for older people. A requirement has been made about these findings. The home is a registered care home to provide care, including nursing care, for older people over the age of 65 years of age. During the random inspection of 10th May 2006, and POVA meetings held during April 2006, evidence suggested that care staff, including nursing staff, must be provided with training to be able to provide adequate care for people living at the care home. Following these POVA meetings staff, including ancillary staff, have attended training in infection control and POVA issues. Arrangements are in place for further training sessions for staff to attend. A recommendation has been made for the existing training programme to continue to be developed. Ringshill Nursing Home DS0000024297.V292338.R01.S.doc Version 5.1 Page 23 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): 31,33,35 & 38 The management arrangements of the home have been poor. The standard of quality assurance systems is adequate but could be improved upon. The safety of the home is poor in some areas. EVIDENCE: Since August 2005 the home has been without a registered manager. Arrangements have been put in place to ensure that the home is managed on a day-to-day basis. A requirement was made following the last inspection for the CSCI to be informed regarding the progress the appointment of a manager and an application to register the manager to be submitted to the CSCI. The timescale for this action was to be no later than 20th March 2006. Although the timescale for action has not been met, information provided to the CSCI, Ringshill Nursing Home DS0000024297.V292338.R01.S.doc Version 5.1 Page 24 during April 2006 at the POVA meetings and during the random inspection of 10th May 2006 indicates that action has been taken to appoint a person to this vacant position. As a result of this action, this requirement has been met. The home is currently managed, on a temporary basis, by an Acting Manager, who is a Registered General Nurse, Staff considered her to be approachable and felt that the management of the home was “going in the right direction”. Staff also considered that the home was managed in such a way to improve the standard of team working. A recommendation has been made for the home to be managed by a registered manager. However, the management of the home has been poor resulting in POVA meetings held during January and April 2006 (see also Standards 4, 8, 18, 27,29 and 30 of this report) and also the number of requirements and recommendations following this inspection. The home has carried out an audit of accidents and has , based on risk assessments, reduced the number of bed rails used by residents. The Acting Manager reported that as a result of this action, there has been a reduction in the number of accidents related to falls and use of bedrails. Documentary evidence to support this was not seen on this occasion. Audits of care plans have been carried out (See Standard 7 of this report) and the Commission receives, each month, a report of a visit carried out by a representative of the Four Seasons Health Care. The Acting Manager stated that no questionnaires have been sent out to gain residents’ views about the standard of care provided by the home. A recommendation has been made for existing quality assurances to be improved upon. A record of residents’ monies, kept by the home for safe-keeping, was satisfactory and it was noted that their monies are kept in a secure manner. Following the inspection of January 2006 a requirement was made to ensure that the health and safety of service users and staff was to be safe guarded at all times, to include regular checks on door closers. Timescale for action was 5th March 2006. However, since this last inspection, the home has been inspected by a fire safety officer (FSO) and a report of this inspection, dated 28th February 2006, has been submitted to the Commission for information purposes. The FSO reported that, “The fire risk assessment for the premises was not satisfactory.” The FSO indicated in their report that the home has until 29th August 2006 to take action to ensure that the home is free of risk from the spread of fire. According to the Acting Manager arrangements have been made for door closures to be provided. The Commission’s timescale for action (with particular regard to door closures) has been met. Ringshill Nursing Home DS0000024297.V292338.R01.S.doc Version 5.1 Page 25 During this inspection 2 immediate requirements were made as 3 fire doors were held open by means not approved by the fire safety officer and 2 fire exits were blocked; one by a hoist and another by rubbish. Kitchen staff reported that although temperatures, were checked on a daily basis for fridges and freezers, these checks were not recorded. The most recent entry for these records was between 3rd and 9th April 2006. A recommendation has been made about this. Records seen, other than those cited elsewhere in this report, for fire safety checks and emergency lighting checks were satisfactory. Staff confirmed that they had received training in fire safety matters although records indicated not all staff have attended training about fire safety, within the last six months. A requirement has been made about this. Ringshill Nursing Home DS0000024297.V292338.R01.S.doc Version 5.1 Page 26 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 1 x 3 1 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 1 9 2 10 3 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 1 2 x x x x x 2 3 STAFFING Standard No Score 27 2 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 2 x 3 x x 1 Ringshill Nursing Home DS0000024297.V292338.R01.S.doc Version 5.1 Page 27 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 OP1 Regulation 4 Requirement The Registered Person must revise the Statement of Purpose and a copy of this submitted to the local area office of CSCI. The Registered Person must not admit outside categories and conditions of registration without prior approval of the CSCI. The Registered Person must promote and make proper provision for the health and welfare of service users. Timescale for action of 16.05.06 not met. Requirement carried forward with new timescale for action. The Registered Person must ensure that service users receive treatment and advice from other health care professionals in a timely manner. Timescale for action of 16.05.06 not met. Requirement carried forward with new timescale for action. The Registered Person must make sure service users are allowed to choose how they wish DS0000024297.V292338.R01.S.doc Timescale for action 01/09/06 2 OP4 CSA 2000 Section 24 23/05/06 3 OP8 12(1)(a) 23/05/06 4 OP8 13(1)(b) 23/05/06 5 OP12 12(2) 01/08/06 Ringshill Nursing Home Version 5.1 Page 28 6 7 OP18 OP19 13(6) 13(4)(b) 8 OP19 23(2)(o) 9 OP25 13(4)(c) 10 11 OP27 OP29 18(1)(a) 19 12 13 OP38 OP38 23(4)(c) 23(4)(a) 14 OP38 23(4)(d) to live The Registered Person must ensure that service users are protected from abuse. The Registered Person must ensure that any activities service users participate in are free from risk The Registered Person must ensure that external grounds, which are suitable, and safe for use, are appropriately maintained. The Registered Person must ensure that unnecessary risks to the health or safety of service users are identified and so far as possible eliminated (with particular regard to hot water temperatures in excess of 43 degrees centigrade). The Registered Person must ensure that staff recruited are competent and experienced. The Registered Person must ensure that all required information is obtained about staff before they commence duty. The Registered Person must ensure that fire door exits are free from obstruction. The Registered Person must ensure that fire doors are not held open by means not approved by the fire safety officer The Registered Person must ensure that all staff attend training in fire safety matters. 23/05/06 16/05/06 16/07/06 23/05/06 23/05/06 23/05/06 16/05/06 16/05/06 01/07/06 Ringshill Nursing Home DS0000024297.V292338.R01.S.doc Version 5.1 Page 29 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 OP15 Good Practice Recommendations 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. The Registered Person should consider ways for 50 care staff to have an NVQ level 2 qualification, or equivalent, in care. The Registered Person should consider ways to develop the existing training programme for staff. The home should be managed by a registered manager. The Registered Person should consider ways to develop existing quality assurance systems. The Registered Person should consider ways to demonstrate that checks of temperatures of kitchen fridges and freezers have been carried out. 2 3 4 5 6 OP28 OP30 OP31 OP33 OP38 Ringshill Nursing Home DS0000024297.V292338.R01.S.doc Version 5.1 Page 30 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 Ringshill Nursing Home DS0000024297.V292338.R01.S.doc Version 5.1 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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