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Inspection on 08/04/08 for Ringshill Nursing Home

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

This inspection was carried out on 8th April 2008.

CSCI found this care home to be providing an Good service.

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

We heard from visitors to the home that the standard of care that their relative was receiving was very good and that the staff were kind, attentive and caring. There has been a sustained commitment in improving the standards of care and the standards of the environment. We heard positive comments about the food and it was described to us as "good".Staff told us that the current Manager is the "best Manager that Ringshill Care Home has ever had."

What has improved since the last inspection?

There were three requirements and 6 recommendations made following the last inspection. All of the three requirements have been met with regards to medication and staff training in infection control and safe moving and handling. Five of the 6 recommendations have been considered. These were regarding admission procedures, medication, choice, protective clothing (for when people have their meals) and activities for people with communication difficulties. The garden areas have improved considerably to be more attractive to see and one of these areas is now safer for people to visit.

What the care home could do better:

Care plans must be up to date and accurate; this is to include a written explanation of why care practices are not carried out according to the plan of care. The accuracy of the records made when medicines are given to people must be improved and when medicines are used on a "when required" basis there must be clear guidelines and records to justify their use. Staff should be made aware of the level of lighting in people`s rooms to ensure that they are safe and comfortable. The home should have 50% of care staff with NVQ level 2. Written and satisfactory explanations for any gaps in employment history must be obtained before the person starts working at the home.

CARE HOMES FOR OLDER PEOPLE Ringshill Nursing Home Sallowbush Road Huntingdon Cambridgeshire PE29 7AE Lead Inspector Elaine Boismier Unannounced Inspection 8th April 2008 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.V361659.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.V361659.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 ringshill@fshc.co.uk www.fshc.co.uk Ringdane Limited (wholly owned subsidiary of Four Seasons Health Care Limited) Mrs Audrey Thorpe Care Home 87 Category(ies) of Old age, not falling within any other category registration, with number (87) of places Ringshill Nursing Home DS0000024297.V361659.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 12th April 2007 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 mainly residential care clients and the upper floor mainly for those people who need nursing care. Fees currently range from £354 to £602. Additional costs include hairdressing, toiletries, private chiropody and newspapers. Further information about fees can be obtained from the home. A copy of the inspection report is available, on request at the home, or via the CSCI website at www.csci.org.uk Ringshill Nursing Home DS0000024297.V361659.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. We, The Commission for Social Care Inspection, carried out this key unannounced inspection, between 9:50 and 15:10 and it took two Inspectors 5 hours and twenty minutes to complete. Before the inspection we sent out surveys for staff, residents and visitors and we received 4 completed surveys from staff and one survey from a visitor. We unfortunately received no surveys back from any resident. The Manager completed an Annual Quality Assurance Assessment (AQAA) before this inspection. Before the inspection we also spoke with a visitor, on the telephone, as they had requested to speak with us. Information from the surveys, the AQAA and the telephone conversation has been used in parts of this report. There is also some information about our contact with the home since the last inspection on the 12th April 2007 and up to this inspection of the 8th April 2008. During this inspection, of 8th April 2008, we spoke with the Manager, staff, residents and visitors to the home. We looked around the home and garden areas, looked at documentation and observed staff working. For the purpose of this report people who live at the care home are referred to as “resident/s”, “people” or “person”. What the service does well: We heard from visitors to the home that the standard of care that their relative was receiving was very good and that the staff were kind, attentive and caring. There has been a sustained commitment in improving the standards of care and the standards of the environment. We heard positive comments about the food and it was described to us as “good”. Ringshill Nursing Home DS0000024297.V361659.R01.S.doc Version 5.2 Page 6 Staff told us that the current Manager is the “best Manager that Ringshill Care Home has ever had.” What has improved since the last inspection? 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. The summary of this inspection report can be made available in other formats on request. Ringshill Nursing Home DS0000024297.V361659.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Ringshill Nursing Home DS0000024297.V361659.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 & 4 Quality in this outcome area is good. There is a good standard of information and a good pre-admission process to ensure that people have enough information about the home, to assist them in their decision where to live and the home can meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The AQAA told us that the Manager assesses all prospective residents before they move into the home, to make sure that the home can meet their needs and from examination of residents’ care files we found that this was the case. A recommendation was made for the home to review the mental health needs of the people living at the home, to ensure that the home was operating within the categories and conditions of registration. Since the inspection in April 2008 we, The Commission for Social Care Inspection, have reviewed our registration process; where a person’s prime Ringshill Nursing Home DS0000024297.V361659.R01.S.doc Version 5.2 Page 9 need, that the home is registered for is greater than their other needs then services may be able to accommodate people with such mixed needs. A copy of the inspection report was available in the home. Ringshill Nursing Home DS0000024297.V361659.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 & 10 Quality in this outcome area is good. People are receiving an improved standard of care although record keeping and medication practices could be improved upon to ensure people are safe at all times. This judgement has been made using available evidence including a visit to this service. EVIDENCE: An examination of people’s care records was carried out on both floors of the home. On the ground floor we found the standard of recording and consultation with the resident was of a good standard. The records provided a detailed picture of the person’s likes and dislikes and choices of how they wished to live. The records also detailed the person’s assessed needs and how these needs were to be met. The care records were evaluated each month although the standard of this could be improved upon that would indicate whether the care plan was meeting the needs of the person, or otherwise. Ringshill Nursing Home DS0000024297.V361659.R01.S.doc Version 5.2 Page 11 On the first floor care plans were sufficient in detail although did not always accurately reflect the care provided. For example care plans for repositioning a person, whilst in bed, stated that this care practice should be carried out every 3 hours. Cross-referencing the repositioning charts indicated that the person was repositioned, whilst in bed, every 2 hours. During the examination of care records on the first floor of the home we noted that the care records indicated that a person was to be weighed each month and to also have their blood sugar levels checked each month. There were gaps in these recordings where the person had not been weighed, between October 2007 and February 2008, and no written explanation given for this omission of care. The person’s weight however had remained unchanged from October 2007 to February 2008. The blood sugar of the person had been checked each month and the results of these checks indicated that the person’s diabetes was stable. However there was no other record of these checks since November 2007, and no written explanation for this omission of care. Other people’s care records for weights and blood sugar monitoring were however satisfactory. As a result of this evidence we consider that, although there are some deficiencies in record keeping, this standard, standard 7, has generally been met with our expectation that such deficiencies are managed by the home, rather than we make a requirement on this occasion. Since our inspections of 2006 and 2007 there has been a reduction in the number of people acquiring pressure sores whilst living at the care home. According to both the Manager and the AQAA only one person has acquired such pressure sores, within the last 12 months. We examined this person’s care notes and it was noted that the person had problems with their pressure areas before they were admitted to the home. Examination of their care records and discussion with the person’s visitors indicated that this person was receiving a good standard of care and that there had been consultation with the tissue viability nurse. Examination of another person’s care records indicated that the person’s long-standing pressure sore was showing signs of healing. The AQAA told us that people have access to a range of healthcare professionals such as GPs, dentists, tissue viability nurses and district nurses. Examination of people’s care records indicated that this was the case. On the day of the inspection we noted a diabetes nurse specialist visiting a resident. Storage facilities for medicines provided on both floors are secure and well controlled in terms of temperature. There are good records of the temperatures of the rooms and of the fridges used to store medicines. Records of the receipt and disposal of medicines are of a good standard. Records of the administration of medicines for people on the ground floor are good, but there were a number of gaps in the administration records for people Ringshill Nursing Home DS0000024297.V361659.R01.S.doc Version 5.2 Page 12 on the first floor and these could be improved. These gaps mean it is not always possible to tell whether medicines had been administered or not and when they were not administered, no reason was recorded. On person was prescribed a medicine “when required for agitation” and this had been administered but the daily records did not describe any justifiable reason why the medicine had been administered. Where medicines are given in variable doses e.g. “one or two tablets” the administration records did not always show the actual quantity given. This could result in people receiving too much or too little medication. A member of the care staff was watched giving medicines to some people during lunchtime and this was done with regard to people’s preferences, personal choice and dignity. Stocks of medicines for people were at an acceptable level and there was no evidence that people had been denied medicines because supplies had run out. The requirement made on the last inspection to ensure adequate supplies of medicines for the continued treatment of residents has therefore been met. Some old supplies of a medicine left over from the previous month had been put in the box with the newer medicines and so the batch numbers were different. This is unacceptable practice and could result in harm to residents if batches cannot be correctly identified. It is expected that this will be managed without the need to make a requirement. The AQAA said that all bedrooms are for single occupancy only to promote privacy of the person and we saw this to be the case. The results of a survey, carried out by Four Seasons Healthcare Limited, in December 2007, showed that staff did not always knock on people’s rooms before entering. An action to be taken by the home was to remind staff about knocking on doors before entering and we noted that staff did knock on these doors before they entered. On the whole we saw staff interacting with residents in a kind and caring manner. Both residents and visitors told us that staff were very good and kind. Ringshill Nursing Home DS0000024297.V361659.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 & 15 Quality in this outcome area is good. People are offered opportunities to live a good quality of life that is continuing to improve. This judgement has been made using available evidence including a visit to this service. EVIDENCE: On the main information notice board, we saw the activities plan for the week although this was hard to read due to the small print used. We read in people’s care records, including those people who remained in bed, activities that were offered to them, including 1:1 talks. On the ground floor we saw a resident playing a game that helped with exercise and co-ordination skills and in the afternoon a number of residents were enjoying a game of bingo. According to the AQAA the home intends to improve the range of activities provided, …”include more individual activities, seasonal related activities” and the Manager confirmed that there is the intention to continue to develop the range of activities on offer. A recommendation was made in the last inspection report, for choice to be offered of how and when people wished to have their personal care. We Ringshill Nursing Home DS0000024297.V361659.R01.S.doc Version 5.2 Page 14 consider this recommendation has been considered following our observation of how staff were offering choice to residents, and what the people and staff told us. We saw people receiving their visitors in private if they wished, and we noted during our examination of people’s records that residents could receive their guests when they like. In response to an anonymous complaint made to us, and subsequently investigated by the home, in September 2007, we were provided, by the home with some of the results, of a Four Seasons Healthcare postal customer survey. These results were of people’s views about the food: “13 said portion of food was excellent; 81 of respondents said food was good and 6 said portions of food were fair. One resident out of sixty in the internal questionnaires said that they were not satisfied with the food.” The people we spoke to said that the food was very good. The AQAA stated that snack meals have been introduced and there has been a change of protective clothing, in response to a recommendation we made following the April 2007 inspection, for when people eat their food and are at risk of spilling it. We saw that there has been a gradual introduction in more suitable protection of people’s clothes when they were eating their lunch. This recommendation has therefore been considered. Ringshill Nursing Home DS0000024297.V361659.R01.S.doc Version 5.2 Page 15 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 Quality in this outcome area is good. People are listened to and are safe from the risk of abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the inspection in April 2007 we have received two concerns about the condition of people’s personal laundry when it has been laundered by the home. We asked for the home to respond to the first concern, from a relative, and we found the response to be of an open and listening manner. For the second concern, from a senior social worker, we advised the person to seek further guidance from the department of health about infection control and temperatures of washing laundry. Since both of these concerns were made known to us, we have had no further complaints about the standard of people’s clothes that the home has laundered. (We observed that the clothes people were wearing, were of a good standard, showed no signs of being ruined and were free from creases.) We received also, in September 2007, an anonymous complaint about the lack of support and supervision of staff and lack of supplies, such as incontinence wipes. We asked the home to investigate this complaint and we considered that the complaint was responded to in a listening and timely manner and that there was no evidence to substantiate the elements of this anonymous complaint. Ringshill Nursing Home DS0000024297.V361659.R01.S.doc Version 5.2 Page 16 Prior to our inspection we spoke with a visitor to the home, via a telephone conversation, and we were informed that although the person had made a complaint about the standard of care provided, the person considered that no satisfactory action had taken place. As a result of this dissatisfaction the person told us that they spoke with the Manager again. The person said that they had initially little confidence in the responsiveness of the home, but felt that this had now improved. The AQAA told us that within the last 12 months the home has received 14 complaints of which 12 were responded to within 28 days. Seven of these 14 complaints were proven. One complaint was currently under investigation. We examined the record of complaints and we consider that the complaints were responded to in a timely and open manner and action had been taken in a listening way. All of the four staff surveys said that the member of staff knew what to do if a concern or complaint was made known to them, by a resident or visitor to the home. In January 2007 we received a telephone call from a member of staff, who made allegations about the standard of care, the standard of record keeping, staff sleeping on night duty, and emotional and physical abuse of 11 residents. Due to these allegations the local safeguarding procedures were initiated, by us, resulting, ultimately, in a full investigation carried out by Four Seasons Healthcare Limited. In October 2007 we attended a meeting to hear the outcome of this extensive investigation and we acknowledged that there was full co-operation and openness, by the registered owner, and action had been taken to reduce the risk of recurring abuse to include unannounced spot checks at night. The other allegations made were difficult to prove or disprove and therefore the outcome of the investigation was “inconclusive”. Discussion with staff and examination of the staff training records indicated that most, but not all, of the staff have attended training in safeguarding procedures. The Manager informed us that arrangements have been made for the remaining staff to attend this training. Some of the staff, who had attended such training, were able to tell us what they would do if they witnessed an incident of verbal of physical abuse. Ringshill Nursing Home DS0000024297.V361659.R01.S.doc Version 5.2 Page 17 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 Quality in this outcome area is good. People live in a safe and homely, clean place that continues to improve. This judgement has been made using available evidence including a visit to this service. EVIDENCE: According to the AQAA the home has contracted a gardener to help with the maintenance of the external areas of the home and we found that this action had greatly improved the garden areas of the home. Although not accessible, but visible from some people’s bedrooms, the surrounding garden area had been cleared of weeds and these now had gravel and park benches. The internal courtyard is safer for people to access and a lawn has replaced an unsafe and unsightly concrete area. According to the Manager there are plans to introduce garden tubs, with plants and flowers, in both of these areas. Ringshill Nursing Home DS0000024297.V361659.R01.S.doc Version 5.2 Page 18 During the tour of the premises we noted a fire escape, although accessible, had some debris, on the main landing and there was some moss and a piece of plastic on the steps. The Manager told us that she had noted this, the day before the inspection, and had taken action for the fire escape to be cleared of any debris or rubbish. There was evidence of a continuing refurbishment programme with carpets being replaced and redecoration of rooms. The décor and furnishings were of a good standard. Some of the bedrooms on the ground floor do not have access to much daylight. We noted that some of these occupied bedrooms were dark and no lights had been put on, although the people were awake. During our revisit to these areas we noted that most of the lights had been put on in the rooms. We discussed this with the Manager for staff to be made aware of such lighting, taking into account people’s safety, comfort and choice. On the 29th October 2007 we received a notification regarding the outbreak of diarrhoea and vomiting amongst a number of residents. The notification informed us that correct procedures had been followed as the public health authority and GP had been notified. We found during our inspection the home was clean and free from stale smells. Ringshill Nursing Home DS0000024297.V361659.R01.S.doc Version 5.2 Page 19 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 Quality in this outcome area is adequate. People are generally safe from staff who are adequately trained and generally well recruited. This judgement has been made using available evidence including a visit to this service. EVIDENCE: According to the AQAA the home has used less agency staff and has recruited more permanent staff, including “two extra registered nurses”. All of the four surveys from staff said that there was usually enough staff on duty to meet the individual needs of the residents although the survey from a visitor to the home said, “There does not seem to be enough carers…The important things for (my friend’s) well-being are not being carried out.” The same survey said , “The care staff are not ever unkind but never seem to have the time to spare so never seem to ask if (my friend) requires any help, with (their) hearing aid, if (they) have any pain, small things but important.” Staff told us that generally there is enough staff on duty although they felt that they did not always have the time to talk to the residents, in an individual way. We timed the response to call bells and this ranged from 2 to 10 minutes. We saw staff caring for people in an unhurried manner and visitors to the home said that staff were attentive to their needs and their relative’s individual needs. Ringshill Nursing Home DS0000024297.V361659.R01.S.doc Version 5.2 Page 20 The AQAA informed us that 20 care staff have left their employment within the last 12 months and according to the Manager the reasons for staff leaving were varied from staff assessed (during their probationary period) not to be suitable to work at the home, or staff finding that they found the work to be unsuitable to them. A recommendation was made for the home to have 50 of care staff to have an NVQ level 2 in care. Information provided in the AQAA told us that of the 39 care staff, six of these have NVQ level 2 in care i.e.15.3 with 3 more staff working towards this qualification. Although this standard has not been met the recommendation is being considered as some staff are working towards this desirable qualification. Three staff files were examined to assess the home’s recruitment procedures. All the required information was available except in one of these files there was an unexplained gap in employment history of 2 months duration. We have taken a reasonable view not to make a requirement on this occasion as we expect the home to manage this issue. We received 4 surveys from members of staff and these told us that the induction training, and ongoing training, covered the areas relevant to the member of staff’s role. Examination of three staff training files indicated that staff have a detailed induction-training programme and the member of staff and a more senior member of staff sign this off, to signify that learning and competencies have been achieved. Following our inspection of April 2007 we made a recommendation for staff to attend training in how to provide appropriate activities for those people who had difficulties in communicating. The Manager stated that she has considered this recommendation and is continuing to find where such training can be obtained or accessed. Ringshill Nursing Home DS0000024297.V361659.R01.S.doc Version 5.2 Page 21 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 Quality in this outcome area is good. People benefit from a well managed and generally safe home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staff told us that Ringshill Nursing Home has greatly improved since the appointment of the Manager in June 2006. One member of staff, who has worked at the home for over 13 years, said, “She is the best yet. She gets things done and she has the best interests of the residents to heart.” The Manager attended a safeguarding course, in February 2008 and the certificate of her attendance was seen. Ringshill Nursing Home DS0000024297.V361659.R01.S.doc Version 5.2 Page 22 The improvements referred to in this report are due to a sustained and improved management of the home. This was the first AQAA she has completed and it was of a good standard. It provided detailed information and identified areas that the home did well in and areas that could be improved upon. Results of surveys carried out by Four Seasons Health care Limited, in December 2007, were seen and these showed that there was 81 satisfaction, from residents and their representatives, about the standard of care provided by the home. According to the Manager reports of monthly unannounced visits made by a representative of Four Seasons Healthcare Limited, are made and these contain details of views of residents, visitors and audits of the home environment and audits of records. Copies of these reports were not seen on this occasion. Following the inspection in April 2007 there has been no change in how the home manages people’s personal monies. Transactions of 3 residents’ monies, held by the home, were checked and these were detailed with types of expenses, such as hairdressing, newspapers, chiropody and toiletries. The records also showed monies coming in and interest accrued. All of the accounts were in the individual residents’ names. A requirement was made following the inspection in April 2007, for staff to attend training in infection control. The AQAA informed us that 38 staff have attended infection control training and we found evidence of this training in the staff training records. This requirement has been met. Following the inspection in April 2007 a requirement was made for staff to attend training in safe moving and handling techniques. Staff told us that they had attended training in moving and handling and refresher training was being arranged. The Manager and staff training records confirmed this to be the case. This requirement has been met. The AQAA told us that an area the home has improved upon is staff attending mandatory training in fire safety and we found that this was the case during our examination of the staff fire training records. The records showed that the last fire drill was carried out in October 2007 although the Manager reported that a fire drill had been carried out on the day before this inspection. The record of this fire drill was not seen on this occasion. Records for checks on emergency lights, fire alarms, hoists, lifts, temperatures of food fridges and freezers were seen and these were satisfactory. Staff told Ringshill Nursing Home DS0000024297.V361659.R01.S.doc Version 5.2 Page 23 us, and this was confirmed by our examination of staff training records, that they have attended training in health and safety and safe keeping of hazardous substances. Records for PAT tests indicated that these are now due. Records for hot water checks, and discussion with the Manager, indicated that action has been taken when the temperature of the hot water, accessed by residents, is greater than 43 degrees centigrade. According to the Manager no resident currently has access one of these identified areas. According to the AQAA 50 of catering staff and 36 of care staff have attended training in safe food handling. Ringshill Nursing Home DS0000024297.V361659.R01.S.doc Version 5.2 Page 24 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 x x 3 3 x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 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 3 x 3 x 3 x x 3 Ringshill Nursing Home DS0000024297.V361659.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? NO 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 OP9 Regulation 12(1) 13(2) Requirement Where residents are prescribed medication on a “when required” basis there must be detailed guidelines for their use and there must be clear records that their use is justified. This will protect residents from harm and abuse. Timescale for action 31/05/08 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.V361659.R01.S.doc Version 5.2 Page 26 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.V361659.R01.S.doc Version 5.2 Page 27 - 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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