CARE HOMES FOR OLDER PEOPLE
Ringshill Nursing Home Sallowbush Road Huntingdon Cambridgeshire PE29 7AE Lead Inspector
Jenny Cangy Unannounced 23 August 2005 @ 11:00 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Nursing Home I03 I53 s24297 RINGSHILL v242316 230805 STAGE 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Ringshill Nursing Home Address Sallowbush Road Huntingdon Cambridgeshire PE29 7AE Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01480 411762 01480 450940 ringshill@fshc.co.uk Ringdane Ltd (wholly owned subsidiary of Four Seasons Health Care) To be appointed Care Home with Nursing 87 Category(ies) of Older people (OP) 87 registration, with number of places Nursing Home I03 I53 s24297 RINGSHILL v242316 230805 STAGE 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: none Date of last inspection 06/01/05 Brief Description of the Service: Ringshill 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 those who need nursing care. Nursing and care staff are employed, night and day, and there are domestic, catering and maintenance staff also employed. The manager is supported by administrative staff. Nursing Home I03 I53 s24297 RINGSHILL v242316 230805 STAGE 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. On arrival at the home for an unannounced inspection the Acting Manager was engaged with staff interviews so the inspector conducted a tour of the ground floor. This is mainly where service users requiring only personal care are accommodated. 12 service users were spoken to at length, three individually and a group of nine in the lounge. Staff members spoken to were helpful and confident. Care staff, kitchen staff and cleaning/laundry staff were spoken to. A number of care plans and drug records were inspected. A meeting with the acting manager was followed by a tour of the first floor. This floor accommodates mainly service users who have nursing care needs. The registered manager has recently resigned and a peripatetic manager from the company is acting as manager. She expects to be in post for about three months while a new manager is recruited. She had only started at the home on the day before inspection. She was keen to ensure that the home’s standards would be maintained and improved during this time. What the service does well: What has improved since the last inspection?
It was not possible to measure this due to the very recent change in management Nursing Home I03 I53 s24297 RINGSHILL v242316 230805 STAGE 4.doc Version 1.40 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Nursing Home I03 I53 s24297 RINGSHILL v242316 230805 STAGE 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Nursing Home I03 I53 s24297 RINGSHILL v242316 230805 STAGE 4.doc Version 1.40 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 4,5&6 No service users are admitted unless their care needs can be met. EVIDENCE: All service users and/or their representatives have the opportunity to visit the home prior to admissions. A copy of the service user guide and statement of purpose is available in each bedroom to inform people of the service available. The home does not provide intermediate care however they do provide interim care to a small number of people awaiting community care or places in other homes. Nursing Home I03 I53 s24297 RINGSHILL v242316 230805 STAGE 4.doc Version 1.40 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9,10&11 Generally care plans were adequate to ensure all needs were being met. Those service users in shared rooms are not having their privacy and dignity met. EVIDENCE: Three shared rooms were found to have no dividing curtains although the curtain tracking was in place. Staff was unable to say when the rooms last had curtains in place. Care plans for service users admitted for interim care are not complete and there is no evidence that full pre-admission assessments are taking place for this group. Vital information was missing from the care plan of a person in interim care. There was no recorded weight on admission despite the fact that her care plan describes her as having a poor appetite. The care plans of permanent service users were detailed and informative. However due to her recent arrival at the home the acting manager was not confident that they were all up to date and would be reviewing them with the staff. No service users self medicate. Service users have access to a full range of health care both within the home and in the community. There are care plans in place outlining service users preferences re dying and death. Nursing Home I03 I53 s24297 RINGSHILL v242316 230805 STAGE 4.doc Version 1.40 Page 10 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 13,14 &15 There are regular and diverse activities to suit the preferences of all service users able to participate. Service users have a choice in all aspects of their daily lives including meals. EVIDENCE: Service users spoken to were enthusiastic about their social lives within Ringshill. They had participated in a sing-a-long on the morning of inspection and were looking forward to a Bingo session in the afternoon. They spoke proudly of their fund raising efforts in the town that involved them dressing up and entertaining people in the market and the local pubs. The activity programme is displayed around the home. Visiting is open within reasonable hours and service users are free to come and go as they wish. Choice is offered in all aspects of daily life including rising and retiring. All service users spoke highly of the choice and quality of food with the only exception being the amount of times soup and sandwiches are the choice for evening meal. Nursing Home I03 I53 s24297 RINGSHILL v242316 230805 STAGE 4.doc Version 1.40 Page 11 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18 Service users are protected from abuse by the homes policies and procedures. EVIDENCE: The staff and management are fully aware of the Protection of Vulnerable Adults team. The home has recently been the subject of a POVA enquiry and a finding of institutional abuse was proved due to use of stained sheets and leaving drinks and food out of reach for service users unable to feed themselves independently. As a result of this the home has taken immediate action to rectify this with an audit of all linen and training for staff. A service user/ relative meeting was held to discuss the issues and concerns of the users. All service users are registered on the electoral roll. The POVA team have a follow up meeting planned to ensure the home has responded appropriately. Nursing Home I03 I53 s24297 RINGSHILL v242316 230805 STAGE 4.doc Version 1.40 Page 12 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,21,23 &26 Some action is needed to ensure the home is providing a safe, clean, hygienic and pleasant environment. Communal areas and bathroom facilities are sufficient. EVIDENCE: The use of wedges to keep bedroom doors open was found. The removal of door closers was also found. All bedroom and communal room doors must only be retained in an open position by means that will be activated on the sounding of the fire alarm. Some areas of the home were found to smell strongly of urine. Two sluice rooms were found to smell overwhelmingly. Service users are able to personalise their rooms. Nursing Home I03 I53 s24297 RINGSHILL v242316 230805 STAGE 4.doc Version 1.40 Page 13 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,29 & 30 Staffing is plentiful and of an appropriate skill mix. EVIDENCE: There are no trained nurse vacancies and vacancies in other staff groups are minimal with agency staff use very low. Staff on the day of inspection were plentiful and observed to be appropriately interacting with service users. Staff training is regular and plentiful. The acting manager stated all new staff recruited have Criminal Record Bureau (CRB) enhanced checked and two written references are required. All staff undergo an approved inductiontraining programme. Nursing Home I03 I53 s24297 RINGSHILL v242316 230805 STAGE 4.doc Version 1.40 Page 14 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,34,35 & 36 There is no registered manager in post but suitable management arrangements are in place to ensure the home is appropriately managed. The management and administrative staff arrangements safeguard the service users’ interests. EVIDENCE: A peripatetic manager from the company is currently managing the home. The acting manager has experience of managing homes on this basis but has never been registered as a manager with the CSCI. There is no deputy manager in post and the need for this post is highlighted by the sudden loss of the manager. The administrator is appointee for 6 service users who do not have family to manage their money. All appropriate records are kept. There is regular formal supervision of all staff and formal records are maintained. The acting manager assures that this will continue in the gap between registered managers
Nursing Home I03 I53 s24297 RINGSHILL v242316 230805 STAGE 4.doc Version 1.40 Page 15 Nursing Home I03 I53 s24297 RINGSHILL v242316 230805 STAGE 4.doc Version 1.40 Page 16 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x x 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 1 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 2 3 3 x 3 x x 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 2 1 3 x 3 3 3 x x Nursing Home I03 I53 s24297 RINGSHILL v242316 230805 STAGE 4.doc Version 1.40 Page 17 no Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 10 Regulation 12(4)(a) Requirement The registered person must ensure that dividing curtains are in place and used to give privacy in shared rooms The registered person must ensure that all service users are protected from instituional abuse and ensure all grades of staff are trained to recognise and deal with the issues highlighted by the POVA investigation The registered person must ensure that no doors are maitained in an open position by any means that does not allow them to close on the sounding of the fire alarm and that any doors that have had closers removed must have them replaced. An assessment of all bedroom doors is needed to ensure they all close on their rebate and that any service users wanting their doors maitained in an open postion have suitable means to enable this. An action plan to meet this requirement must be submitted to theCSCI The registered person must ensure that all areas of the home are free form unpleasant odours Timescale for action 5th September 2005 Ongoing 2. 18 12 3. 19 23(4) 30th September 2005 4. 26 16 (2)(k) 30th September 2005
Page 18 Nursing Home I03 I53 s24297 RINGSHILL v242316 230805 STAGE 4.doc Version 1.40 and that staff are trained appropriately to deal with this. 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 Good Practice Recommendations Nursing Home I03 I53 s24297 RINGSHILL v242316 230805 STAGE 4.doc Version 1.40 Page 19 Commission for Social Care Inspection CPC1, Capital Park Fulbourn Cambridge CB1 5XE National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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