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Inspection on 25/01/06 for Ringshill Nursing Home

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

This inspection was carried out on 25th January 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

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

The home has a full and varied activities programme with both regular events such as bingo, religious services and sing-a-longs. There are also regular trips out and outside entertainers coming in to entertain the service users. Several service users are regularly involved in fund raising events and enjoy going out in the local area in fancy dress as part of this. There is an excellent courtyard garden that service users have access to and use well during the fine weather. The home appeared to be well staffed and staff interact well with the service users. The home is an approved centre for the adaptation of foreign trained nurses to become registered in the UK. Although the home has a number of service users with pressure sores the majority of these were hospital acquired. The home has a good tissue viability programme with named nurses appropriately trained. Pressure relieving aids are plentiful and treating, monitoring and preventing pressures sores programmes are in place.

What has improved since the last inspection?

The ground floor corridors have new carpet and the dining room and dining room annex has wood effect flooring laid. This has greatly improved the appearance of this area adding light and freshness to a previously dark and stale smelling area. All shared rooms now have dividing curtains to ensure the privacy and dignity of the occupants.

What the care home could do better:

In some areas of the home unpleasant odours were apparent. Although the manager was aware of the problem and the cause the staff have so far failed to resolve the problem. Some care plans did not have all the sections completed leaving information about service users history unavailable to the care staff.

CARE HOMES FOR OLDER PEOPLE Ringshill Nursing Home Sallowbush Road Huntingdon Cambridgeshire PE29 7AE Lead Inspector Mrs Jenny Cangy Unannounced Inspection 25th January 2006 12:00 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.V276505.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.V276505.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 Ltd (wholly owned subsidiary of Four Seasons Healthcare). Care Home 87 Category(ies) of Old age, not falling within any other category registration, with number (87) of places Ringshill Nursing Home DS0000024297.V276505.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 23rd August 2005 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. Ringshill Nursing Home DS0000024297.V276505.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection commenced at 12.00 noon with a tour of the ground floor and time spent with service users in the dining room. A meeting with the acting manager followed when some records were checked and a review of the standards not met or not inspected at the last visit took place. A tour of the first floor then took place. During the tour of the building staff, service users and visitors were spoken to. Tour of the ground floor. The lounge was empty as service users had gone to the dining room for lunch. In the lounge there was an underlying smell of urine masked by air freshener. The corridor leading from the lounge to the care staff work station was clean and fresh and new carpet had been laid since the last visit. All the bedroom doors were fully closed on their rebate and the rooms were clean and fresh. The occupants name was on each door. The carers work station is in need of refurbishment as the surface veneer was damaged with some exposed chipboard presenting a hazard. There was a smell of urine in this area and two bedrooms entered had stained carpets and unpleasant odours. In the subsequent corridor some doors were not closing adequately on their rebate and one door had no door closer on it. This would present a hazard in the event of a fire. One bedroom and an adjacent bathroom were out of use due to leaking pipe-work. Remedial work was underway. One service user had a cracked bedroom window. The manager stated that a new glass was on order. Several doors including bedrooms, sluice and laundry need adjustment due to not adequately closing on their rebate. The dining room and annex area have had new wood effect flooring laid since the last inspection. This has greatly improved the appearance of the area making it brighter and easier to keep clean and fresh. The inspector spent some time in the dining room talking to service users and staff and observing lunch being served. The overall opinion expressed by the service users was satisfaction with their surroundings and the care they received. They spoke positively about the standard of the food on the whole. Several service users talked enthusiastically about the recent Christmas activities and the visit by local television news cameras to film the staff pantomime. They also spoke of their fund raising efforts and appeared to greatly enjoy their lives. Tour of the first floor The Lounges on the first floor were empty but were found to be clean and fresh. The majority of the service users were in bed or sitting in their own rooms. The first floor provides mainly nursing care. Some bedrooms did not have names on the doors. Part of the first floor is used for interim care with people awaiting care packages at home following discharge from hospital. All areas of the first floor were found to be clean and free from offensive odours. It was noted that service users needing specialist equipment had this provided. Meeting with Acting Manager The standards not met and those not inspected at the last inspection were reviewed. A previous Protection of Vulnerable Adults issue was discussed and the acting manager updated the Ringshill Nursing Home DS0000024297.V276505.R01.S.doc Version 5.1 Page 6 inspector on the progress regarding the service users involved. At the end ot the tour of the building the inspector fed back her finding to the acting manager. What the service does well: What has improved since the last inspection? What they could do better: Ringshill Nursing Home DS0000024297.V276505.R01.S.doc Version 5.1 Page 7 In some areas of the home unpleasant odours were apparent. Although the manager was aware of the problem and the cause the staff have so far failed to resolve the problem. Some care plans did not have all the sections completed leaving information about service users history unavailable to the care staff. 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.V276505.R01.S.doc Version 5.1 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Ringshill Nursing Home DS0000024297.V276505.R01.S.doc Version 5.1 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 Service users have all the information they need to make an informed choice before moving into the home. They have a contract stating the terms and conditions of residence that clearly outlines their rights as service users and all prospective service users have a needs lead assessment. EVIDENCE: The service user guide and statement of purpose has recently been reviewed and updated. This contains all the information needed to enable the service users to make choices and raise concerns. There are two statements of terms and conditions of admission and residence. One is for people funded independently and one for those placed by the local authority, the latter complimenting the agreement between the local authority and the Company. All prospective service users have a full needs led assessment by a senior member of staff prior to admission. This includes people being admitted to interim care beds. Ringshill Nursing Home DS0000024297.V276505.R01.S.doc Version 5.1 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 10 All service users have their right to privacy and dignity respected. EVIDENCE: There are dividing curtains in place in shared rooms to ensure privacy is respected. All service users are able to lock their doors if they wish. All bathrooms and toilets have locks on the doors and personal care is only carried out in the privacy of bedrooms or bathrooms. Staff were observed interacting with service users in a polite appropriate manner. Ringshill Nursing Home DS0000024297.V276505.R01.S.doc Version 5.1 Page 11 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 Service users able to participate have a full programme of activities. Those who are too frail to participate have one to one time on a regular basis from the activity co-ordinator. EVIDENCE: A programme of activities is displayed around the home. Service users spoke enthusiastically about the activities that happened over the Christmas period and the fact that their home had twice featured on local television news with regard to their fund raising activities and the pantomime performed by staff (with some service user involvement) for the service users. Other activities include bingo, sing-a-longs, religious services , arts and crafts and whatever other ideas the service users think of. The activities co-ordinator is enthusiastic and dedicated. Outside entertainers are also a regular feature. Ringshill Nursing Home DS0000024297.V276505.R01.S.doc Version 5.1 Page 12 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, 17, 18 Service users and their representatives are able to make complaints in the knowledge they will be heard and appropriately responded to. Service users legal rights as citizens are maintained. Service users are protected from abuse. EVIDENCE: There is a formal complaint procedure in place that is displayed around the home and contained in the service user guide. All complaints are appropriately responded to and the acting manager and the area manager regularly audit any complaints. The information about where to complain includes the contact number and address of the CSCI. All service users are included on the electoral roll and enabled to exercise their vote in a way they prefer. Contact is made with legal advisors when required. All staff have had Protection of Vulnerable Adult (POVA) training and POVA issues are reinforced on a regular basis. Any POVA strategy meeting outcomes are fed back to staff and the outcomes discussed. The provider and management team have responded appropriately to recent POVA issues relating to inappropriate moving and handling techniques and concerns raised about the vulnerability of two service users. The latter resulting in the service users involved having a planned move to a home with the specialist facilities they needed. Ringshill Nursing Home DS0000024297.V276505.R01.S.doc Version 5.1 Page 13 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, 22, 24, 25, 26 On the whole service users live in a safe well maintained environment However there are doors that need attention to ensure they shut adequately. Any specialist equipment needed is obtained and service users personal space is safe comfortable and personalised. Some small areas of the home do not meet the standard for hygiene and freshness. EVIDENCE: Some doors are not shutting adequately on their rebate presenting a hazard in the event of fire. This included one door that has had its closer removed meaning it will remain in an open position unless pulled shut physically. This was a requirement at the last inspection and as it was different doors at this inspection, it is the inspectors opinion that a routine of regular checks on all doors is needed to ensure doors are adjusted regularly. The home is well equipped with hoists and pressure relieving aids. Any specialist equipment needed will be acquired. Bedrooms are comfortable, well decorated and personalised. The ground floor lounge had an underlying smell of urine as did the area around the ground floor care staff station and two bedrooms. Although the acting manager was aware of the problem steps must be taken to manage this problem. Ringshill Nursing Home DS0000024297.V276505.R01.S.doc Version 5.1 Page 14 Ringshill Nursing Home DS0000024297.V276505.R01.S.doc Version 5.1 Page 15 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): 0 These standards were all inspected and met at the last inspection EVIDENCE: Staff rotas were supplied to the inspector and staffing levels were good at the time of inspection. Ringshill Nursing Home DS0000024297.V276505.R01.S.doc Version 5.1 Page 16 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 37, 38 The home has no manager registered with the CSCI. The home is being run in the best interests of the service users and regard for their rights and health and safety are promoted and respected. EVIDENCE: The home currently has no manager registered with the CSCI however a peripatetic manager from the company is acting as manager until a new manager is appointed. She has been in post for over 6 months and in this time has ensured that all policies and procedures have been maintained and the home continues to move forward. The length of time the home has been without a registered manager is now in excess of 6 months and this should be addressed as a matter of urgency. All records are kept as required and staff recruitment procedures ensure the safety of the service users are protected. The home has named staff responsible for health and safety issues. It should be noted that doors not closing adequately on their rebate present a hazard in the event of fire and this issue was identified at the last inspection. However The doors identified at this inspection are different to those at the last Ringshill Nursing Home DS0000024297.V276505.R01.S.doc Version 5.1 Page 17 inspection. The inspector feels a regular programme of checking and maintaining all doors is needed to ensure the safety of the service users. Ringshill Nursing Home DS0000024297.V276505.R01.S.doc Version 5.1 Page 18 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 X 14 X 15 x COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 2 X X 3 X 3 3 2 STAFFING Standard No Score 27 X 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 3 X X X 3 2 Ringshill Nursing Home DS0000024297.V276505.R01.S.doc Version 5.1 Page 19 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 OP19 Regulation 23(4) Requirement Timescale for action 05/03/06 2. OP26 16(2)(k) 3. OP31 8 4 OP38 23(4) The registered person must ensure that any doors that have had closers removed must have them replaced. An assessment of all room doors is needed to ensure they all close on their rebate The registered person must 05/03/06 ensure that all areas of the home are free from unpleasant odours and that staff are trained appropriately to deal with this. The registered person must 20/03/06 notify the CSCI regarding the progress to appoint a manager and an application to register the manager must be submitted to the CSCI immediately on appointment and no later than 20th March 2006. The registered person must 05/03/06 ensure that the health and safety of service users and staff is safe guarded at all times. To this end a programme of regular checks on door closers should be implemented. Ringshill Nursing Home DS0000024297.V276505.R01.S.doc Version 5.1 Page 20 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Ringshill Nursing Home DS0000024297.V276505.R01.S.doc Version 5.1 Page 21 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. 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