CARE HOMES FOR OLDER PEOPLE
Ringway Mews Nursing Home Stancliffe Road Sharston, Wythenshawe Manchester M22 4RY Lead Inspector
Geraldine Blow Unannounced Inspection 28th November 2006 09:30 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 Ringway Mews Nursing Home DS0000021656.V319631.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. Ringway Mews Nursing Home DS0000021656.V319631.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Ringway Mews Nursing Home Address Stancliffe Road Sharston, Wythenshawe Manchester M22 4RY 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) 0161 491 4887 0161 428 6991 www.bupa.com BUPA Care Homes (CFHCare) Limited Stephanie Maginn Care Home 150 Category(ies) of Dementia - over 65 years of age (30), Old age, registration, with number not falling within any other category (120) of places Ringway Mews Nursing Home DS0000021656.V319631.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. All service users require nursing care. The number of service users for whom accommodation is provided at any one time shall not exceed 150 patients of either sex aged 60 years or over. Up to 30 service users who are over the age of 60 and who additionally have dementia may be accommodated on Halifax Unit. The service should, at all times, employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection 31st May 2006 Date of last inspection Brief Description of the Service: Ringway Mews is a care home providing nursing care and accommodation for a maximum of 150 older people. Within this maximum number, accommodation is provided for 30 older people with dementia type illnesses. However, one of the houses that provided nursing care was currently closed. The home is owned by BUPA Care Homes. The home is situated in the residential area of Wythenshawe, which is to the South of the City of Manchester. There is easy access to the Manchester ring road motorway system as well as easy access to public transport systems, which are within walking distance of the home. There is ample parking within the grounds of the home. Wythenshawe Civic centre is easily reached by car and there are local shops, which are within walking distance of the home. The home is purpose-built and consists of 5 separate single storey houses. Each house provides accommodation for 30 residents and stands within its own garden area. The administration area, laundry, hairdressers, and central kitchen are housed in a central building that is accessible by a covered walkway. Ringway Mews Nursing Home DS0000021656.V319631.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection report is based on information and evidence gathered by the Commission for Social Care Inspection (CSCI) since the home was last inspected in May 2006. On the day of this inspection site visit the Pharmacist Inspector also visited the home to undertake a specialist pharmacist inspection. This visit was an unannounced site visit, which forms part of the overall inspection process, and was conducted by 2 inspectors. The visit took place on Tuesday 28 November 2006. The opportunity was taken to look at all the key standards of the National Minimum Standards (NMS) and the requirements made at the inspection in May 2006. This visit was also used to decide how often the home is to be visited and to make sure that it meets the required standards. During the visit time was spent talking with the operations manager, the manager, people who live at the home, a visitor to the home, observing how staff work with people and taking to staff on duty. Documents and files relating to residents and how the home is run were also seen and a tour of the building was made. The key inspection report of May 2006 highlighted a number of areas that the home needed to work on and improve. The home had addressed some of the changes needed from the last inspection report, however, some concerns remain about the management of medication. If the home continues to fail to fully address these concerns the CSCI will take action to ensure the concerns are addressed. . The CSCI is carrying out a Thematic Probe exercise as part of its inspection over a two-week period. The areas of focus for the inspection are National Minimum Standards (NMS 1, 2, 3 and 16) that relate to the theme of the quality of the information given to prospective residents. the contract of terms and conditions for those people who are privately funded residents. It also looked at the provision of assessments of residents needs before they came to live at the home and whether they had been provided with information about how to raise their concerns and make a complaint. Relevant files and documentation were seen and discussions held with the owner if the home and, where possible, residents. The outcome of the findings is recorded in the main body of the report. Ringway Mews Nursing Home DS0000021656.V319631.R01.S.doc Version 5.2 Page 6 What the service does well:
The home continued to carry out a pre admission assessment of each prospective resident before admission to the home to make sure that the home could meet the person’s needs. After the pre admission assessment the home confirmed in writing to the resident that they were able/not able to meet their needs. Residents or their representatives were given information regarding the home at this pre admission stage to help them make a decision about whether they would like to go to the home. Once the resident is admitted to the home a ‘welcome pack’ which included a ‘Service User Guide’ was given to them. This included further information about the home. Residents who were paying privately for their care had a personal contract with the home and for those residents who are funded by the Local Authority and the Primary Care Trusts the home had a contract with that purchasing authority. The home continued to have an open visiting policy. Residents, a visitor and staff spoken to confirmed this. The visitor spoken to said that staff were very friendly and made her feel welcome when she visited. A choice of meals was available at each mealtime and the residents spoken to confirmed this. Staff said that if residents did not want what was on the menu they could request an alternative meal. From observations made and from talking to residents it appeared that the privacy and dignity of residents was protected and that residents were able to have choice with regard to their every day life. One resident said that she liked to read so the staff always made sure she was sat under a lamp or took her back to her room where it was quiet for her. She also said that she could go to bed and get up when she liked, she said all she had to do “was ask a member of staff to help her back to bed and they did”. Systems were in place to support residents or visitors to make a complaint. Residents spoken to confirmed this and a visitor spoken to said that the family had raised 2 concerns with staff and both times the issues had been dealt with. They said that they felt very comfortable bringing complaints or concerns to the attention of the staff as they always listened and seemed to really care about the residents. The home had a robust recruitment procedure to ensure that staff employed were suitable to work with residents. Ringway Mews Nursing Home DS0000021656.V319631.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection?
Since the last inspection, the home had worked hard to meet the requirements in relation to the residents individual plans of care and improvements were seen. They contained more detail and had regularly been reviewed and updated. Although improvements were seen regarding the handling of medication further improvements were still needed to ensure the safety of residents. These are detailed below. The home recently undertook a staff survey to try to find out how the staff feel about the home and their work. The results of the survey had been looked at and the home were going to develop an action plan to look at some of the issues raised such as recruitment, work satisfaction and moral and skills mix. Seeking staff views and taking positive action towards improving the standards and skills of the staff team was seen as an example of good practice. The last inspection report identified that Halifax House had an unpleasant odour in the entrance hall. However on a tour of the house during this visit there was no odour and the house was generally clean and tidy. Since the last inspection visit the lounge has had a new carpet laid. In an attempt to reduce the risk of cross infection the last inspection report recommended that an individual sling should be provided for each resident requiring the use of the hoist. The manager said that they bought new slings and more were on order, so slings were no longer shared. Since the last inspection visit the home had employed several Registered Mental Nurses (RMN’s). The unit manager co-ordinator of Halifax House, the Dementia Care unit, said that the unit now had a RMN on duty 24 hours a day. Since the last inspection visit the activities coordinators have been working with residents to develop new ideas and events. One such activity was supporting residents to play musical instruments. The home’s Induction Programme had been updated to reflect the National Skills for Care Induction Modules and staff were supported through the Induction Programme by the Training Coordinator and the unit managers. Staff also had the opportunity to have regular supervision that focused solely on their training needs and skills development. Each member of staff had a training profile that was used to log all the training events that they have undertaken and evidence was seen that staff working with residents diagnosed with dementia undertook specific training in this area.
Ringway Mews Nursing Home DS0000021656.V319631.R01.S.doc Version 5.2 Page 8 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. Ringway Mews Nursing Home DS0000021656.V319631.R01.S.doc Version 5.2 Page 9 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 Ringway Mews Nursing Home DS0000021656.V319631.R01.S.doc Version 5.2 Page 10 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 & 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents have the information they need to make a decision about the home. The home undertakes an assessment of prospective residents’ care needs prior to their admission. EVIDENCE: BUPA had a standard information pack that included general information regarding BUPA Homes and a Statement of Purpose that was specific to Ringway Mews. The manager said that all prospective residents or their representatives were given the pack and then on admission to the home residents were given a welcome pack, which included a Service User Guide. At the time of this visit the manager was in the process of updating the welcome pack. If residents are funded through purchasing authorities (Local Authority and Primary Care Trusts) then the contract is between the resident and the
Ringway Mews Nursing Home DS0000021656.V319631.R01.S.doc Version 5.2 Page 11 authority and not with the home itself. The home is paid in full by the authority and not by the resident. Issues such as fees, third party contributions, and notice of termination are included in the contract. Therefore, if a resident wanted to leave the home, or the home wanted to ask the resident to leave then the purchasing authority has to be notified. Also increases in fees or other contributions are decided by the purchasing authority and residents are notified by letter of any changes. If the resident is privately funded then the contract, with terms and conditions, is between the home and the resident. The contract used by the home is a standard pro-forma developed by the owners of the home, BUPA. The contract clearly states the fees and any other charges for services. Changes in the contract or in fees are notified to the resident through a separate letter. The home had a documented pre admission assessment form that was used to ensure that prospective residents were only admitted on the basis of a full assessment of need being carried out. Evidence was seen that for those residents who were referred through Care Management arrangements the home obtained a summary of the Care Management Assessment. Following the pre-admission assessment the home confirmed in writing to the prospective resident that the home was able/not able to meet their assessed needs. Where possible, prospective residents and their family/representative were encouraged to view the home prior to making a decision about admission. The home did not provide an intermediate care service Ringway Mews Nursing Home DS0000021656.V319631.R01.S.doc Version 5.2 Page 12 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 poor. This judgement has been made using available evidence including a visit to this service. Although the care planning process had improved to ensure residents’ health and personal care needs are met, the systems and procedures for dealing with medicines required further improvement in order to protect residents. EVIDENCE: A random sample of care plans was examined on Halilfax House and Anson House. Improvements were seen since the last inspection visit in May 2006 and the requirements made in the last report had been met. The care planning process starts when the resident arrives at the home. A named nurse, or the nurse on duty is responsible for completing the care plan pack. This has to be completed within 72 hours of the resident’s arrival. Care plans are then evaluated on a monthly basis by the named nurse, if possible. Changes in residents’ health and care needs should be identified and the nurse in charge should make the necessary additions/changes to the care plan and the support.
Ringway Mews Nursing Home DS0000021656.V319631.R01.S.doc Version 5.2 Page 13 The home had its own review and auditing process. This involved the deputy manager checking the monthly evaluations and spot checks on residents’ care plans. Evidence was seen where a residents care plan had been reviewed and audited. Omissions and the need for updates were identified and an action plan set out how the care plan needed to be improved. These actions and changes were then checked again by the deputy manager to make sure they had been completed. However, the evaluation/review sheet did not clearly identify which problem area was being evaluated. In addition to the homes review process, residents’ support and care was reviewed annually through the care management/review system of the purchasing local authority and by a nursing review from the relevant Primary Care Trust (PCT). Each file reviewed was found to contain an assessment undertaken on admission and a care plan had been generated if appropriate. In the main plans of care were found to set out the action that needed to be taken by staff to ensure that the health and personal and social care needs of the residents are met and appropriate risk assessments had been. It was encouraging that individual preferences had been included in the care plan. For example, one file stated that the resident “prefers male carers”. In Halifax House, the Dementia care unit, the files reviewed demonstrated that relatives had completed a brief history and details around an average day for the resident. One care plan clearly documented “fluid intake to be monitored”. An input and out put chart had been implemented. However, there were gaps in the recording of the output rendering the record inaccurate. In the main the care files were seen to contain a lot of information and were generally quite difficult to follow and were not particularly user friendly. However, in one file, dividers were in place to separate the sections. This was found to be easier to read. In another care file 2 care plans were in place for the same identified problem, which was confusing. The unit manager coordinator said that care plan had been rewritten and the old one had not been removed. It is recommended that the care files are reviewed and organised in a more user-friendly format. Residents and family involvement in developing care plans was currently ‘haphazard’ with some individual examples of family involvement. The home had started to put in place a more formal system for encouraging residents, families and other relevant people in the development and review of care plans. Residents and families are also invited to the annual care management and nursing review. It is recommended that the home make sure that they clearly record and evidence how and when residents and families were involved in developing, updating and reviewing the care plan.
Ringway Mews Nursing Home DS0000021656.V319631.R01.S.doc Version 5.2 Page 14 Residents were registered with a General Practitioner and evidence was seen of referral to other specialised services according to individual assessed needs. Medication handling on Halifax Unit had been seen to be unsafe on a number of previous inspections. On this inspection it was seen that the unit had made a significant improvements in recording medication. However despite all the improvements nurses had failed to record some medication when it arrived, they failed to record the number of tablets given when the dose was variable, they had also altered the Medication Administration Record Sheets (MARs) when doses had changed making it impossible to tell what had been given. Carers were delegated the task of applying creams to residents. These carers did not always sign the MARs to show that they had done so and the nurses failed to make sure that the carers did sign the sheets to say they had administered the creams. The nurses could not provide evidence by means of a reliable audit trail that residents were given their medicines as prescribed. The home failed to provide evidence that the residents’ health was not at risk. There were also serious concerns that medication was not administered as the GP intended. There were a number of instances where medication had been given but not signed for or signed for but not given. Medication for some residents had run out. If residents’ do not receive medicines properly their health could be at risk. One resident received another resident’s medication by accident, the error was fully documented and the appropriate actions were taken to make sure this resident was safe from harm. The resident whose medicine had been administered in error, to another resident, was not given any medicine at all. It is of serious concern that this resident’s health was placed at risk and that the nurses did not fully protect the resident’s health. Nurses also failed to make appropriate checks, as outlined in the Nursing and Midwifery Guidelines, such as taking residents’ pulses before giving certain medication The temperatures at which medicines were stored were of concern. If medicine is not stored at the correct temperature it may harm the residents’ health. The medication room was very warm. There was an air-conditioning unit in the room but it was not being used. The temperature of the fridge was too low. Some items, which were in the fridge, should have been stored at room temperature. Ringway Mews Nursing Home DS0000021656.V319631.R01.S.doc Version 5.2 Page 15 Nurse failed to put the date of opening on items of medication that had a limited life once open. This could lead to medicine, which is out of date being administered, which could harm residents’ health. The home no longer keeps any homely remedies, such as Paracetamol for pain relief. This means that residents who have a simple ailment such as a headache cannot be given pain relief. The manager of this unit could not describe what actions she would take if a resident had a simple headache when the doctor’s surgery was shut. The home is not meeting the diverse needs of their residents by not being able to treat simple ailments. The home have a number of monitoring methods in use to ensure that medication was given safely. Unfortunately the systems have failed to ensue the safety of residents. The home has persistently failed to safeguard the heath and well being of the residents by continually failing to meet the requirements issues after the last two specialist pharmacist’s inspections on 29-06-05 and 31-05-06. The day after the inspection the managers sent detailed information on how they were improving their monitoring systems to increase medication handling and to make sure residents were safe. From observations made during the inspection and discussions with members of staff and residents it appeared that the nurses and care staff treated the residents with respect and dignity. Ringway Mews Nursing Home DS0000021656.V319631.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Activities were provided and residents were able to maintain contact with family and friends. Residents were able to exercise choice and control over their lives and the residents enjoy the meals that they choose. EVIDENCE: The home continued to employ activity co-ordinators who arrange approximately 80 hours of social events a week across the four units. Activities include clothing shows, quizzes, beauty therapies and hairdressing. The activities coordinators have been working with residents to develop new ideas and events. One such activity is supporting residents to play musical instruments. During the summer the home arranged four trips to Blackpool. Photographs were on display of birthday celebrations and the visitor spoken to said that her mother particularly enjoyed the quiz on a Tuesday. Ringway Mews Nursing Home DS0000021656.V319631.R01.S.doc Version 5.2 Page 17 The home has links with the local church where some residents go to services and social events and local church members come in to visit residents at the home. Most community contact was through the visiting of family and friends. The home had an open visiting policy and visitors could be received in the residents’ own room or any of the communal areas of the home. Staff, residents and the visitor spoken to during the visit confirmed this. Residents confirmed that they were given choices with regard to their day to day lives. For example one resident goes to visit her daughter every week and another resident said that she enjoyed watching the late news before going to bed. These individual and personal choices were not clearly documented in all the plans of care. A recommendation was made that the individual plans of care reflect the personal choices and preferences made by residents. The menus offered a variety of wholesome and nutritious meals. A choice of meals were offered and staff confirmed that snacks and drinks were given on request. Staff said that if resident did not want what was on menu they could request an alternative. Ringway Mews Nursing Home DS0000021656.V319631.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home encouraged and supported people to raise their concerns and complaints and had the policies, procedures and systems in place to protect residents from abuse. EVIDENCE: Since the last inspection, the home had received six complaints in relation to the service the home provides. The majority of these complaints were dealt with by the home at the informal stage. The manager had maintained clear and detailed records of the complaints and concerns and the actions taken to resolve any issues raised. Several examples was seen of letters and cards from families complimenting them on the care provided to their family members who are/were residents at the home. The home supports a number of residents whose health needs may result in behaviour that was challenging to the staff and place the resident, staff and other residents at risk. This was a particular issue for the Halifax Unit, which specialises in supporting people with dementia. The home has a clear policy and procedure on the ‘Management of Aggression’ that sets out how the home and staff must work with residents and includes guidance on the use of ‘physical intervention’.
Ringway Mews Nursing Home DS0000021656.V319631.R01.S.doc Version 5.2 Page 19 At the present time there was no specific training for staff in implementing the policy. However, staff who work on the unit are required to undertake specific training in understanding dementia. In addition, the Unit Manager is currently undertaking a training event to be able to train staff in how to work with and manage challenging behaviour, including the use of ‘breakaway techniques’. It is recommended that the registered provider should ensure that all staff have a working knowledge of the Management of Aggression Policy and procedures and in working with residents whose behaviour may challenge the service. It is also recommended that the registered person should ensure that relevant risk assessments and support guidance, in relation to managing residents challenging behaviour, are completed as part of the care planning process. Ringway Mews Nursing Home DS0000021656.V319631.R01.S.doc Version 5.2 Page 20 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 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The premises generally were clean and comfortable for the residents living there. EVIDENCE: The home continues to provide large grounds with a variety of garden areas, which are accessible to those residents who are wheelchair bound. The home was furnished to an acceptable standard and was suitable for the residents living there. On the day of this visit the houses visited were odour free and were found to be clean and tidy. Residents and the visitor spoken to said that the home was usually clean, tidy and odour free. Bedrooms were personalised with items brought in from resident’s own homes. Ringway Mews Nursing Home DS0000021656.V319631.R01.S.doc Version 5.2 Page 21 The laundry was situated away from residents living and eating areas. Soiled linen did not come into contact with food storage, preparation, cooking, serving or dining areas. The manager said that the home had bought a number of new hoist slings so that there were enough slings for each resident in an attempt to reduce the risk of cross infection. Ringway Mews Nursing Home DS0000021656.V319631.R01.S.doc Version 5.2 Page 22 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 good. This judgement has been made using available evidence including a visit to this service. The number and deployment of staff appeared sufficient to meet the residents’ assessed needs. The procedures for recruiting staff were robust and provided adequate safeguards to protect residents. EVIDENCE: On the day of this visit the numbers and skill mix of the staff appeared to be sufficient to meet the needs of the number of residents accommodated. The home had a staff team consisting of 26 qualified nursing staff and approximately 100 non-qualified care staff. The home acknowledged that over the past 12 months staff turnover had been high compared to the average turnover within the care sector. The reasons for this was explained as a result of the home aiming to improve the quality of the staff team and setting higher standards. Staff who had been unable to meet the standards required had therefore left the home. Since the last inspection the Dementia Care Unit had employed several RMN’s and now had an RMN on duty 24 hours a day. Carers on the unit confirmed that they had received Dementia care training, which they found useful in understanding and meeting the needs of the residents accommodated.
Ringway Mews Nursing Home DS0000021656.V319631.R01.S.doc Version 5.2 Page 23 The home recently undertook a staff survey to try to find out how the staff feel about the home and their work. The results of the survey have been looked at and the home were going to develop an action plan to look at some of the issues raised such as recruitment, work satisfaction, staff moral and staff skill mix. Obtaining staff views and taking positive action towards improving the standards and skills of the staff team is commended as an example of good practice. Since the last inspection visit, the CSCI had received an anonymous concern regarding the staffing levels at the home. The Responsible Individual appropriately responded to the CSCI with a written response to the concern. The manager stated that they were committed to providing the non-qualified staff with vocational qualifications. At the time of the site visit just under 50 of the staff had gained the NVQ Level 2 with a further 12 currently undertaking the qualification. Examples of staff files had CRB’s, POVA First checks, references and other relevant documentation. All appropriate safety checks were carried out to ensure that the staff member is safe to work with vulnerable adults. The home’s Induction Programme had been updated to reflect the national Skills for Care Induction Modules. The initial Induction Programme covered all the required modules and involved both in-house and external training providers. In addition, staff then have to complete a 12 week Induction portfolio and complete key mandatory training. The training coordinator works with staff during the induction programme to ensure they understand the modules and have the competence to put them into practice. The managers of the separate units were also responsible for ensuring that staff are competent and meeting the standards required to meet residents needs. Staff also have the opportunity to have regular supervision that focused solely on their training needs and skills development. Evidence was seen that staff working with residents diagnosed with dementia undertake specific training in this area. Each member of staff had a training profile that logs all the training events that they have undertaken. The training coordinator has undertaken an audit of the training that staff have undertaken and started to put in place a training programme to ensure that they receive the required updated and refresher training. This was still in progress and was an ongoing process. Therefore the Ringway Mews Nursing Home DS0000021656.V319631.R01.S.doc Version 5.2 Page 24 registered provider should continue to ensure that staff have received the training required to undertake their role. Ringway Mews Nursing Home DS0000021656.V319631.R01.S.doc Version 5.2 Page 25 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Systems and procedures were in place, which safeguards and protects residents’ financial interests and the home was seen to promote the health, safety and welfare of the residents and staff. EVIDENCE: The residents in the home continue to benefit from a committed and experienced manager who is a qualified nurse. She has a wide variety of nursing experience and has undertaken a wide range of training, which includes the Registered Managers Award.
Ringway Mews Nursing Home DS0000021656.V319631.R01.S.doc Version 5.2 Page 26 The previous inspection report highlighted that BUPA had undertaken a quality survey of the residents in the home in August 2005 and produced a report of the finding in February 2006 in an attempt to review the quality of the service being provide by the home. The home has introduced residents’ meetings where family and friends are also invited to attend and can discuss their concerns or any issue they feel needs addressing. The minutes of the last meeting raised issues such as maintenance, catering, laundry and housekeeping, activities and security. The home has a clear and transparent system for managing and recording the personal finances of those residents that they previously had responsibility for through being the appointee. The system in place was that either the resident, their family/representative or the relevant local authority was responsible for the personal finances. All transactions and documentation was regularly audited and monitored both by the home and through the main organisation (BUPA). Evidence was provided that the home ensures the health, safety and welfare of the residents and staff are protected at all times. The fire logs were seen at the last inspection visit and the required checks had been made. Ringway Mews Nursing Home DS0000021656.V319631.R01.S.doc Version 5.2 Page 27 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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 1 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 x 3 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 3 x 3 x 3 x x 3 Ringway Mews Nursing Home DS0000021656.V319631.R01.S.doc Version 5.2 Page 28 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)(a) 13 (2) Requirement To ensure the health, welfare and safety of residents the registered provider must ensure that: 1. The registered person must ensure accountability for all medication is evidenced by accurate record keeping, including homely remedies. 2. The registered person must ensure that medication is stored within manufacturers recommended temperatures and that nurses are aware of what action to take in the event of medication being stored incorrectly. 3. The registered person must ensure Medication is administered in strict accordance with prescriber’s directions at all times. 4. The registered person must ensure a robust ordering system is implemented to ensure that medication is available for all
Ringway Mews Nursing Home DS0000021656.V319631.R01.S.doc Version 5.2 Page 29 Timescale for action 31/12/06 service users. (Outstanding since 29-06-05 and 31-05-06) 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 OP7 Good Practice Recommendations 1. It is recommended that the evaluation sheet clearly identifies which problem area is being evaluated. 2. It is recommended that the home make sure that a clear record is made and evidence of how and when residence and family are involved in developing, updating and reviewing the care plan. 3. It is recommended that the care files are reviewed and organised in a more user-friendly format. It is recommended that input and output charts are accurately maintained. It is recommended that the individual plans of care reflect the choices made be residents regarding personal preferences and choices over their day to day lives. 1. It is recommended that the registered provider ensure that all staff have a working knowledge of the Management of Aggression Policy and procedures and in working with residents whose behaviour may challenge the service. 2. It is recommended that the registered person ensure that relevant risk assessments and support guidance, in relation to managing residents challenging behaviour, are completed as part of the care planning process. The registered provider should continue to ensure that staff have received the training required to undertake their role. 2. 3. 4. OP8 OP14 OP18 5. OP30 Ringway Mews Nursing Home DS0000021656.V319631.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection CSCI, Local office 9th Floor Oakland House Talbot Road Manchester M16 0PQ 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
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