Inspection on 31/05/06 for Ringway Mews Nursing Home

This inspection was carried out on 31st May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Ringway Mews Nursing Home 15/12/09

Ringway Mews Nursing Home 23/02/09

Ringway Mews Nursing Home 16/04/08

Ringway Mews Nursing Home 05/06/07

Ringway Mews Nursing Home 28/11/06

Ringway Mews Nursing Home 21/02/06

Ringway Mews Nursing Home 29/06/05

Ringway Mews Nursing Home 21/02/05

Ringway Mews Nursing Home 05/07/04

Ringway Mews Nursing Home 16/01/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Ringway Mews Nursing Home Stancliffe Road Sharston, Wythenshawe Manchester M22 4RY Lead Inspector Geraldine Blow Key Unannounced Inspection 31st May 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.V296790.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.V296790.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.V296790.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 21st February 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, at the time of writing this report one of the houses that provided nursing care was 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. The fees charge range from £402.76 to £640.24 per week. Information about the home can be gained through contacting the registered provider (BUPA). Ringway Mews Nursing Home DS0000021656.V296790.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report is based on information gathered by CSCI since the last inspection on 21 February 2006 and some supporting information received in the preinspection questionnaire that was submitted to CSCI by the home and the requirements made at the last inspection. This visit was unannounced and forms part of the overall inspection process, it was conducted by 2 inspectors and took place on Wednesday 31 May 2006. The opportunity was taken to look at all the core standards of the National Minimum Standards (NMS) and the requirements made at the inspection on 21 February 2006. This inspection was also used to decide how often the home is to be visited to make sure that it meets the required standards. On the day of this inspection the Pharmacist Inspector also visited the home to undertake a further specialist pharmacist inspection. A number of concerns were identified and a separate letter has been sent to the responsible individual. The requirements and recommendations made by the pharmacist inspector are included in this report. As part of the visit time was spent with the residents who live at the home, observing how staff work with residents, discussions with staff and the registered manager, assessing relevant documents and files and a tour of the premises was undertaken. The last inspection to the home identified a number of areas that the home needed to improve to meet the NMS, although some things had improved some areas have not been addressed and therefore a number of requirements had not been met and have been put back into this report. Since the last inspection CSCI has received 2 complaints about the home. One complaint had been investigated by the home and the other complaint was investigated as part of this inspection. Ringway Mews Nursing Home DS0000021656.V296790.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? It was required at the last inspection that the adult protection procedure must be easily accessible to all staff. Each unit now has a copy for staff to follow if an allegation of abuse is made and the home manager is not available. The home now had all the relevant contact phone numbers to report any allegations of abuse. Since the last inspection the home has better clarification to the homes recruitment process in order to ensure that the staff are safe to work with the residents. Ringway Mews Nursing Home DS0000021656.V296790.R01.S.doc Version 5.2 Page 7 Halifax House had introduced protective meal times, which had resulted in meal times being a more relaxed, social occasion where resident are encouraged to eat meals uninterrupted. The home has a quality assurance system to seek the views of the people who use the service and the inspectors saw a report based on the results of questionnaires sent out. It is recommended that the home manager produce an action plan based on the report in order to further develop 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 manager said that the home had filled all the qualified nurse posts and were not relying on agency staff to fill gaps in cover. There are some vacancies for night care assistants and the home is actively trying to fill these posts. Any gaps in cover are being filled with agency staff. What they could do better: As stated in the last inspection report the residents’ plans of care still needed improvements to meet the required standard. The plans of care still not contain enough detail to ensure that all the needs of the residents are met and following the monthly review the care plans must be properly updated. The systems and procedures for dealing with medicines still needed improvements to protect residents. Many of the concerns raised had been highlighted at the previous inspections. It is of concern that little improvement had been made with regard to all aspects of medication handling, for example, due to poor recording of medication by the nurses it was difficult to know if the medication had been given and some medication had not been given at the prescribed time. At the last inspection it was required that the home make sure that all its staff had received adult protection training. The requirement has not been fully met. However the homes training manager is developing an in-house adult protection training programme and will be prioritising its implementation. At the last inspection it was reported that a Consultant Psychiatrist in Dementia care had assessed the care on Halifax House, the Dementia Care Unit and had produced a report, which contained a number of recommendations. At the time of this inspection, it appeared that none of the recommendations had been met, although the manager said it was the homes intention to meet the recommendations. The progress of this will be assessed at the next CSCI visit to the home. During a tour of the building it was seen that the hoist slings that are used to help move less mobile residents were stored in the storeroom on top of each Ringway Mews Nursing Home DS0000021656.V296790.R01.S.doc Version 5.2 Page 8 other. This poses a risk of cross infection and it is recommended that each resident, who needs the use of the hoist, should have his or her own sling. As identified at the last inspection there was an unpleasant odour in the entrance hall of Halifax House. This is an on-going issue at the home and the manager said that a further wall-mounted deodoriser was due to be fitted. 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. Ringway Mews Nursing Home DS0000021656.V296790.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.V296790.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3&6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service The home undertakes an assessment of prospective residents’ care needs prior to their admission. EVIDENCE: The referral process for new residents would involve contact from either a private individual or through a purchasing authority (health or social services). The person and /or family would be invited to visit the home and to see the bedrooms that were available. Information, including the home’s Statement of Purpose, menu and activities list, would be provided to the person/family to help them make a choice. The manager or a member of the management team will make a personal visit to see the person and undertake an initial pre-admission assessment. In addition, assessments from social and health services are gathered. This information is then used to decide whether the home is able to meet the Ringway Mews Nursing Home DS0000021656.V296790.R01.S.doc Version 5.2 Page 11 person’s needs and to look at issues such as compatibility with other residents. For privately funded people, the home undertakes its own pre-admission assessment. The home does not provide an intermediate care service Ringway Mews Nursing Home DS0000021656.V296790.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 at least once during a 12 month period. 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 Each resident had an individual plan of care. However, some areas of the plan required improvements to ensure residents’ health, personal and social care needs are fully met. The systems and procedures for dealing with medicines needed to be improved to protect residents. EVIDENCE: The manager said that the home undertook a care planning review process in August/September 2005 and that all the care plans were checked to ensure that they contained the relevant information. It is the Deputy Manager’s role to undertake regular reviews of residents’ care plans to make sure that they are up-to-date and relevant. However, detailed below are some concerns that were identified during an inspection of a random selection of care plans. Ringway Mews Nursing Home DS0000021656.V296790.R01.S.doc Version 5.2 Page 13 The unit manager of Halifax House, who took up post 4 weeks ago said that she and the junior sister on the unit were in the process of reviewing all the care plans on the unit as they were aware of a number shortfalls. Each resident had an individual plan of care which contained a photograph for easy identification and risk assessments were seen to be included. However, during the inspection of the care files some serious concerns were identified. Generally the care files were difficult to follow and were not user friendly. There did not appear to be any systematic order to the care files i.e. care plans did not follow risk assessments and evaluations did not follow the care plans. The monthly reviews of the care plan are recorded as taking place, however it appears that a thorough assessment of needs did not taking place. For example, one care plan had documented that the Waterlow score was 14 yet the actual Waterlow assessment documented the score to be 18. This information had not been included in the documented monthly reviews. In addition in the ‘eating and drinking’ section of the plan of care documented “for covert medication”. No evidence was available to support the entry. One area of concern was that in one file it was clearly documented in January 2006 that protective headwear was required for a resident. There was a further entry in April 2006 requesting the headwear but there was no evidence that this request had been followed up or that the resident had received the headwear. The progress information for one resident documented that nutritional supplements were being given. However, there was not a care plan supporting this or any record of food intake to ensure that adequate nutrition was being maintained. One care plan clearly documented “fluid intake to be monitored”, there was no evidence to support that this had been implemented. Another progress information entry clearly documented that a resident had been given a double dose of insulin, however a short-term care plan had not been implemented outlining the actions and observations to be taken to manage the situation. The care plans were of varying standards but generally they were quite vague containing entries like “assist to wash and dress every day “ and “assist with oral hygiene”. In order to ensure all appropriate care is given to residents the care plan must set out in detail the actions which need to be taken by staff and a thorough review must take place and the care plan be amended and updated as required. There was some evidence that the plan of care had been drawn up with the involvement of the resident/relative and the unit manager said that she was in the process of seeing all relatives, where possible, to generally discuss the unit Ringway Mews Nursing Home DS0000021656.V296790.R01.S.doc Version 5.2 Page 14 and the delivery of care. It was then her intention to hold a formal meeting to discuss the care plans. The recommendation made at the last inspection that the daily progress record of care should contain more detail to accurately reflect the nursing care provided to residents had not been fully met. The entries were found to be of varying standards. Due to above issues and the unmet requirements from previous inspections it is recommended that a full audit of all care plans be undertaken to ensure that all resident needs are met. Residents were registered with local General Practitioners and had access to visiting healthcare professionals e.g., Dietician, Chiropody, Dentistry and Ophthalmology. The home gave an example where they were concerned about the changing behaviour of a resident on the dementia unit. A call was made to the G.P and they made a referral direct to the local psychiatric consultant who visited the resident that day to assess his behaviour and review the medication regime. The home can also gain input from a specialist consultant psychiatrist through BUPA and they had undertaken a review of the dementia unit and identified areas of improvement that can be made. The home can also access the local palliative nursing service. An example was given where the service was involved in developing a Pathway Plan for a terminally ill resident. The specialist nurse worked with the family and with the staff team in providing support and guidance. A letter was seen from the family expressing their thanks for the support and care given to their parent. This ensured residents were in receipt of appropriate health services necessary to support their health care needs. As already identified in this report the pharmacist inspector has undertaken a specialist pharmacist inspection. A number of serious concerns were identified and discussed with the home manager, such as some MAR’s had been altered in such a way as to make it impossible to evidence exactly what medicine the resident had received, the recording on the Medication Administration Records sheets (MARs) was poor for some residents and on occasions it was difficult to determine if medication had been administered, and some medication had not been stored properly. A separate letter will be produced containing her findings. However requirements made by the pharmacist inspector are included in this report. The manager expressed the view that the way that people are shown respect and dignity should be based on the individual resident and their needs. Generally, principals and actions such as knocking on bedroom doors, privacy in personal care, delivering mail direct to the resident are discussed and past Ringway Mews Nursing Home DS0000021656.V296790.R01.S.doc Version 5.2 Page 15 onto staff during the staff induction and followed up through the supervision process. 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.V296790.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 at least once during a 12 month period. 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 employed 2 activity co-ordinators and evidence was seen that activities were taking place. It was encouraging that the unit manager of Halifax House had spoken to the activity co-ordinator about spending 1:1 time with a number of residents and was looking at varying the activities provided. It was her intention to develop a fruit and vegetable patch for residents to help tend. One member of staff said that a trip to Blackpool was organised for 16 June 2006 and that residents regularly went out for days and the home held clothes shows and had outside entertainers in. Also the home discussed with residents some ideas for activities. One suggestion was a Punch and Judy show so the home put on a show with puppets for the residents. The home has been asked by the local authority to present the show in the community and some of the residents will attend these shows. Ringway Mews Nursing Home DS0000021656.V296790.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 is 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 spoken to during the inspection confirmed this. As already mentioned in this report the principals of providing residents with choices and control over their daily lives are passed to the staff through the training programme. It is recommended that these choices should be reflected through the home’s care planning process. It was encouraging that information regarding local advocacy services was on display on the units. The menus offered a varity of wholesome and nutritious meals. A choice of meals were offered and staff confirmed that snacks and drinks were given on request. It was encouraging that on Halifax House the unit had implemented ‘protective meal times’. Also on the same unit it had been clearly documented in one care file a detailed list of likes and dislikes of a vegetarian resident. Ringway Mews Nursing Home DS0000021656.V296790.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 inspected at least once during a 12 month period. 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 has the systems and procedures in place that allow people to express their complaints/concerns. However, people are not fully protected as all staff had not undertaken the relevant training. EVIDENCE: The manager acknowledged the important role that staff play in their relationships with residents and families in dealing with informal concerns and complaints. The manager stated that staff were being encouraged and supported to become more involved with residents families so that any concerns can be dealt with at the earliest opportunity and not develop into complaints. Several examples were seen of cards and letters from residents’ families complimenting the home on the support and care that they had provided. Ringway Mews Nursing Home DS0000021656.V296790.R01.S.doc Version 5.2 Page 19 As previously stated in this report, since the last inspection the home had received an allegations of abuse. This had been reported by the home and investigated by Social Services. All appropriate action had been taken. Since the last inspection CSCI has received 2 complaints about the home. One complaint had been investigated by the home and the other complaint was discussed with the manager as part of this inspection. It was requested that the manager provide CSCI with a written response to some of the issues discussed. The previous inspection report highlighted the need for the home to make the adult protection procedures readily available. The home has provided a copy of the procedures in the office of each unit for staff to use if the management team are not available. The manager has access to the local authority procedures for Manchester and Cheshire. This action has met the previous requirement. The home were also required to ensure that all its staff had received adult protection training. The training manager had recently undertaken an audit of training needs and identified a high percentage of staff who had not received this training. The training manager is developing an in-house adult protection training programme and will be prioritising its implementation. This part of the requirement is reiterated. Several residents do present behaviour that can challenge the service. Evidence was seen of some risk assessments relating to how staff are to work with residents’ behaviour. However, these risk assessments are not up-to-date and there was little guidance to provide staff with the information they need to support residents. The manager acknowledged that the relevant staff required additional training in this area. BUPA has its own in-house training programme that the manager was going to access. Due to a concern raised by a resident’s family over staff purchasing items for residents, this practice has now been stopped to ensure there is no risk to vulnerable residents. Ringway Mews Nursing Home DS0000021656.V296790.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 at least once during a 12 month period. 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 provides large grounds with a variety of garden areas, which are accessible to those residents who are wheelchair bound. On the day of inspection it was seen that some areas of the garden were looking slightly overgrown. The gardener said that he was in the process of mowing all of the lawns and cutting back the overgrown shrubs. CSCI had received a complaint regarding the cleanliness of the home and one room in particular on Shackleton House. A tour of Shackleton House and the room in question was inspected. Generally the unit was clean and tidy, Ringway Mews Nursing Home DS0000021656.V296790.R01.S.doc Version 5.2 Page 21 however it was noted that part of the corridor carpet was marked and slightly stained. It is recommended that this carpet be thoroughly cleaned. The room in question was also seen to be generally clean, although the flooring was marked and showing signs of general age and ‘wear and tear’. In addition it was noted that the wall the bed was against had smears of chocolate on. The complaint was discussed with the manager and a written response to CSCI was requested. The rest of the premises were generally clean and tidy. The manager stated that there had been some difficulties in filling vacancies for housekeeping staff. They had recently appointed and were still recruiting some staff and each unit now had its own housekeeper. It was encouraging to note that in order to help prevent risk to residents the sluice doors and treatment rooms were locked when not in use. The manager said that every 12 months she meets with the estate manager to set a plan of spending requirements for the buildings and environment. The manager stated that the home had access to funds and would be planning a refurbishment programme of all the units over the coming year. 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. As already referenced in this report during a tour of the building it was seen that the hoist slings were stored on top of each other in the storeroom. This poses a risk for cross infection and it is recommended that each resident, who needs the use of the hoist, should have their own slings. Ringway Mews Nursing Home DS0000021656.V296790.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is adequate. 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. However, the home was unable to demonstrate that its staff had completed the required training to meet residents needs. The procedures for recruiting staff were robust and provided adequate safeguards to protect residents. EVIDENCE: The manager stated that the home now had a full compliment of qualified staff and were not relying on agency staff to fill gaps in cover. There are current vacancies for night care assistants and the home are actively recruiting to fill these posts. Agency staff are used to address shortfalls in staffing. The home now ensures that they have details of exactly which agency staff are working in the home and where they working. On the day of the inspection the staffing numbers appeared appropriate to meet the needs of the residents accommodated. However it was of concern that the nursing Dementia Care Unit employed only 1 full time RMN. This was discussed with the unit manager and the homes manager who both said that a further RMN had been employed and was due to start in the next 4 weeks. In addition the unit manager, an RGN, was scheduled to attend a number of relevant Dementia Care study days and was in the process of looking for a Ringway Mews Nursing Home DS0000021656.V296790.R01.S.doc Version 5.2 Page 23 higher level of Dementia Care study, possibly at diploma level. Carers on the unit confirmed that they had received Dementia care training. As already referenced in this report there is now better clarification on the use of POVA checks as required at the last inspections. If the CRB for new employees has not been received within 2 weeks then a POVA first is applied for and the member of staff works under supervision until the CRB clearance is received. Also the documentation relating to work permits are now checked by the administrator and the home can also access the BUPA department that deals with overseas workers. The home were also required to ensure that it had the relevant documentation in relation to workers from overseas. The manager stated that all documentation was now checked by her and the home’s administrator to ensure the documentation is correct. In addition BUPA has a department that deals solely with employing workers from overseas and they can give advice and support if required. This action met the previous requirement. Staff files contained all the required documentation and checks required to ensure that the staff are safe to work with residents. The previous inspection report highlighted that the home needed to ensure that all its staff had access to mandatory and updated training. The recently appointed training manager has undertaken an audit of all staff records relating to training. She identified gaps in staff training, induction and no system had been put in place which identifies when staff required updated training. The requirement was reiterated. In addition during the audit of training, information relating to which staff had achieved the NVQ Level 2 Award was often missing from staff records and so accurate figures could not be maintained. It is recommended that these figures be maintained. The home was also required to review the Induction programme to ensure it met the national vocational standards. BUPA was in the process of reviewing its induction programme and would be introducing the programme. In an attempt to improve the care planning process all recently appointed qualified staff have had to undertake a care planning exercise as part of the interview process to ensure that they have the understanding and skills required. The home’s training manager has undertaken a review of qualified staff understanding and implementation of the care planning process. This has highlighted that a number of qualified staff require further training and awareness in applying the care planning systems including recording. The home must ensure that its qualified staff have the knowledge and skills in developing and implementing the home’s care planning process. Ringway Mews Nursing Home DS0000021656.V296790.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 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 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.V296790.R01.S.doc Version 5.2 Page 25 The previous inspection report highlighted that the home needed to ensure that it had a formal quality assurance system in place. 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. The manager has not yet developed an action plan from these findings and so it is recommended that an action plan be developed addressing the issues raised in the report. 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 seen that the home ensures the health, safety and welfare of the residents and staff are protected at all times. The fire logs were seen and the required checks had been made. Ringway Mews Nursing Home DS0000021656.V296790.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 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 2 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 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.V296790.R01.S.doc Version 5.2 Page 27 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 OP7 Regulation 13 & 15 Requirement 1. Residents care plans must be written with sufficient and accurate detail to provide clear guidance to staff of the actions to be taken to meet the residents health and welfare needs. 2. The plan of care, where possible, must be drawn up with the involvement of the resident in a style accessible to the resident. Once agreed it must be signed for by the resident whenever possible and/or their representative. (Previous timescale of 31/8/05 and 21/03/06 had not been met) 3. The plans of care and risk assessments must be accurately reviewed and updated. (Previous timescale of 21/03/06 had not been met) 2. OP8 12, 17 SCh 3&4 1. Where concerns are identified with regard to residents food intake a detailed record must be DS0000021656.V296790.R01.S.doc Timescale for action 03/07/06 03/07/06 Ringway Mews Nursing Home Version 5.2 Page 28 maintained to enable any person inspecting the record to determine whether the diet is satisfactory in relation to nutrition and hydration. 2. In order to promote and make proper provision for the health and welfare of residents’ referrals must be followed up in a timely manner to access specialist equipment e.g. protective headwear. 3. OP9 13 1. The registered person must ensure that staff administering medication adhere to guidance issued by the Royal Pharmaceutical Society and Nursing and Midwifery Council in respect of the safe receipt, administration and disposal of medicines in the home (Previous timescale of 29/06/05 had not been met) 2. The registered person must ensure accountability for all medication is evidenced by accurate record keeping, including homely remedies. 3. 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. 4. The registered person must ensure Medication is administered in strict accordance with prescriber’s directions at all times. 31/05/06 Ringway Mews Nursing Home DS0000021656.V296790.R01.S.doc Version 5.2 Page 29 5. The registered person must ensure a robust ordering system is implemented to ensure that medication is available for all service users. (Previous timescale of 29/06/05 had not been met) 6. The registered person must ensure that all nurses administering medication undergo medication training (Previous timescale of 10/03/06 had not been met) 7. The registered person must ensure that all nurses administering medication must have their competency to do so assessed. 8. The registered person must ensure the supplying pharmacy is contacted to discuss supply of medication, including the packaging of medicines (Previous timescale of 29/06/05 had not been met) 1. Evidence must be provided that all staff have received Protection of Vulnerable Adult training which includes the actions to be taken in the event of an allegation of abuse. (Previous timescale of 21/03/06 had not been met) 2. The registered person must ensure that risk assessments are undertaken in relation to residents’ behaviour that may challenge the service and that clear and appropriate support guidance is provided to the Ringway Mews Nursing Home DS0000021656.V296790.R01.S.doc Version 5.2 Page 30 4. OP18 13 31/07/06 relevant staff. Where required, training in how to understand and work with challenging behaviour must be provided to the relevant staff. 5. OP30 18 1. All staff must undertake the necessary mandatory (including refresher) training and have an individual staff training and development plan. (Previous timescale of 01/05/06 had not been met) 31/07/06 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 daily progress record of care should contain more detail to accurately reflect the nursing care provided over a 24-hour period. 2. It is recommended that a full audit of all care plans be undertaken to ensure all residents care needs are met. 2. OP9 1. It is recommended that the home should make sure that handwritten entries on the MARs are signed by the member of staff making the entry and countersigned by a second member of staff, to check the accuracy. 2. It is recommended that the home should make sure that all homely remedies are stored separately from prescribed medication 3. 4. OP14 OP26 It is recommended that the individual plans of care reflect the choices made be residents regarding personal choices over their day to day lives. In an attempt to prevent the risk of cross infection it is recommended that an individual sling should be provided for each resident requiring the use of the hoist. DS0000021656.V296790.R01.S.doc Version 5.2 Page 31 Ringway Mews Nursing Home 5. 6. OP28 OP30 It is recommended that the figures relating to which staff have achieved the NVQ Award and those yet to start be maintained 1. It is recommended that the home reviews and updates it Induction programme before the deadline set by Skills for Care of September 2006. 2. It is recommended that the home’s Induction and training programme contain systems for assessing and confirming the competence of staff having undertaken any training programme. 7. OP33 It is recommended that the homes manager produce an annual development plan based on the results of the quality assurance questionnaire. Ringway Mews Nursing Home DS0000021656.V296790.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection CSCI, Local office 9th Floor Oakland House Talbot Road Manchester M16 0PQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Ringway Mews Nursing Home DS0000021656.V296790.R01.S.doc Version 5.2 Page 33 - 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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