Inspection on 03/10/05 for Risby Hall Nursing Home

This inspection was carried out on 3rd October 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

Risby Hall Nursing Home 29/08/07

Risby Hall Nursing Home 07/09/06

Risby Hall Nursing Home 05/05/05

Risby Hall Nursing Home 01/02/05

Risby Hall Nursing Home 06/07/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bramley Avenue (73)

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Risby Hall Nursing Home Hall Lane Risby Bury St Edmunds Suffolk IP28 6RS Lead Inspector Cecilia McKillop Announced Inspection 3rd October 2005 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Risby Hall Nursing Home DS0000024480.V256477.R01.S.doc Version 5.0 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. Risby Hall Nursing Home DS0000024480.V256477.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Risby Hall Nursing Home Address Hall Lane Risby Bury St Edmunds Suffolk IP28 6RS 01284 810921 01284 810754 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) Risby Hall Nursing Home Limited Mrs Yvonne Ball Care Home 36 Category(ies) of Old age, not falling within any other category registration, with number (36), Physical disability (4) of places Risby Hall Nursing Home DS0000024480.V256477.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 5th May 2005 Brief Description of the Service: Risby Hall is a care home for older people providing nursing care for 36 service users. The home has been established for many years under the proprietorship of Risby Hall Nursing Homes limited. The registered proprietors are actively involved in the management of the home. Risby Hall is situated on the edge of Risby village west Suffolk and was built from what were originally the farmhouse and outbuildings. The accommodation is all on the ground floor with level access throughout. The facilities are homely and comfortable and there are 20 single bedrooms and 8 shared rooms. Risby Park, which is also a care home for older people, is located adjacent to Risby Hall. Risby Hall Nursing Home DS0000024480.V256477.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report follows an announced inspection, which took place between 10am and 4pm during a weekday. The inspector toured the home, examined records, spoke with the staff on duty, service users and visiting relatives. The manager Mrs Yvonne Ball assisted the inspector throughout the day. The unannounced inspection had previously been undertaken on the 5th of May 2005. What the service does well: What has improved since the last inspection? The home has recently developed its own newsletter, which is given to service users and their families and provides information about recent events as well as plans for the future. Risby Hall Nursing Home DS0000024480.V256477.R01.S.doc Version 5.0 Page 6 The home’s policies and procedures have been updated and are now bound into two volumes, which should ensure ease of access for staff. The quality and the amount of detail contained in the care plans has improved since the last inspection, with staff documenting both nursing and social needs. The bathroom has been refurbished and looked clean and pleasant. A new walk in shower was in the process of being installed and when complete it should provide greater choice for service users. 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. Risby Hall Nursing Home DS0000024480.V256477.R01.S.doc Version 5.0 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 Risby Hall Nursing Home DS0000024480.V256477.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 5 Prospective service users can be assured that their needs will be assessed prior to their admission. Friends and family are encouraged to visit the home and assess its suitability. EVIDENCE: Service users needs are assessed prior to their admission and the manager visits the service user at home or in hospital. The assessment process and findings are well documented. Families and service users are encouraged to visit and look around the home prior to an admission. There was some discussion at the inspection about the fact that a small number of service users had developed dementia while resident at the home. The care plans relating to these service users were examined as part of the inspection and it was noted that they addressed their primary nursing needs but also their wider social and mental heath needs. A number of staff had undertaken training in dementia and further training for staff was planned. The home is arranged in a manner that is not best suited for service users with dementia and the manager was clear that this was an area Risby Hall Nursing Home DS0000024480.V256477.R01.S.doc Version 5.0 Page 9 that the home was not intending to specialize in but that they would continue to meet the needs of the service users currently in residence. Risby Hall Nursing Home DS0000024480.V256477.R01.S.doc Version 5.0 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 Each service user’s needs are clearly set out in an individual plan of care and Service users can expect that their needs will be met and that they will be treated in a respectful manner. The health and welfare of service users is protected by the homes policies and procedures for dealing with medicines. EVIDENCE: The care plans for four service users were examined and these were of a good standard. There was clear information about service users needs and how staff should provide the care. Staff were recording on a daily basis and there was evidence that service users care was being monitored and regularly reviewed. Staff were working with other health professionals such as dieticians, dentists, speech therapists and chiropodists. There were clear records of the GP visits and the advice given. A number of service users were using air mattresses and there were plans in place to monitor and treat pressure areas. There were auditing arrangements in place to look at the incidence of pressure sores, how they arose, the treatments and changes. Risby Hall Nursing Home DS0000024480.V256477.R01.S.doc Version 5.0 Page 11 The interaction observed by the inspector between staff and service users was warm and friendly. Staff knocked on doors and waited before entering. Service users spoke of the kindness of staff and confirmed that they were treated in a respectful manner. Pharmacist inspector Mr M Andrews undertook the inspection of the medication systems on 4th October 2005. The inspector found the home has satisfactory systems in place for the ordering, receipt, administration and record keeping of medication. Overall, he found medication practice was found to be of a good standard and there to be a high commitment to training and maintaining the competence of registered nurses. The inspector identified an issue relating to the storage of controlled drug temazepam which requires remedial action, however, other areas of medication practice discussed during the inspection have led to recommendations intended to enhance the home’s practice and thereby assist in protecting the health and welfare of individual service users. A full pharmacy report has been submitted to the providers alongside this report and is available on request. Risby Hall Nursing Home DS0000024480.V256477.R01.S.doc Version 5.0 Page 12 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, 14, 15 Service users can expect to be able to exercise choice over their diet and how they spend their time. Service users are enabled to maintain contacts with friends and family. EVIDENCE: The home has an activity organiser who works each weekday with service users. On the afternoon of the inspection a group of service users participated in a sing along with a number of musical instruments. A programme of the week’s activities is posted in each service users bedroom and this included things such as games and slide shows on Suffolk from years gone by. Some service users were looking forward to a boat trip to the Norfolk Broads, which was due to take place within a few days of the inspection. There is weekly physiotherapy session, which is run by a Physiotherapist for which there is a small charge payable. The home has a small library and a number of new games had recently been donated. The home has also organised a newsletter in which it outlines recent developments. Service users reported that they were able to either have their own telephone or use the homes telephone to maintain contact with friends and family in the Risby Hall Nursing Home DS0000024480.V256477.R01.S.doc Version 5.0 Page 13 community. The inspector was informed that assistance can be given with the organisation of transport where needed. Relatives are welcomed at the home and a small number of relatives visit on a daily basis and assist at lunch. The lunch served on the day of the inspection looked appetising and service users had a choice. The cook was observed preparing an alternative for a service user who declined what was on offer. Service users said that the food was very good and the portions were of a good size. Staff were observed making service users comfortable before starting to help them eat. The pureed meals were nicely presented and were kept warm and covered as they were being transported. Service users are able to bring some of their personal possessions with them when they mover into the home and a number of the rooms had been personalised. There was a discussion about service users access to their records, and the manager confirmed that this would be enabled. However the manager was unable to find clear documentation/ guidance on this for staff or service users. Risby Hall Nursing Home DS0000024480.V256477.R01.S.doc Version 5.0 Page 14 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 People who use this service can expect that their concerns and complaints will be acted on, and steps taken to satisfactorily resolve them EVIDENCE: The home has a complaints procedure, which is outlined in the welcome pack, which, is provided to service users on admission. The commission has not received any formal complaints about this service since the last inspection. Relatives who were spoken with as part of the inspection confirmed that they were aware of the procedure and when an issue was raised, the homes management dealt it with appropriately. Service users were able to identify a member of staff that they would speak with should they have a concern about their care. Risby Hall Nursing Home DS0000024480.V256477.R01.S.doc Version 5.0 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22, 23, 26 People who use this service can expect to live in a clean and comfortable environment and have access to a range of equipment to maximise their independence. EVIDENCE: The accommodation was found to be comfortable, and generally well maintained. The home is all one level and is generally accessible. There is a small step however at the front door and staff cover this with mobile cover when service users who are wheelchair dependant request to go out. The paving/concrete outside is somewhat uneven, and the inspector was informed that there are plans to level this area and improve access. There is a large central sitting and dining room and chairs are arranged in such a way as to encourage discussion between small groups. Service users eat in a variety of locations, the dining table, in their chair or in their bedroom. Risby Hall Nursing Home DS0000024480.V256477.R01.S.doc Version 5.0 Page 16 There was a range of specialist equipment available to assist service users, including hoists, chairs and specialist mattresses. The inspector was informed that a recent audit on the hoists had been undertaken which looked at their use and general wear and tear. As a result there were plans to purchase a number of new slings. The radiators have all now been fitted with covers which provides protection to service users. There has been some refurbishment of the bathrooms and they now look much more inviting. There remain some ongoing storage issues particularly with commodes as some were being stored in a toilet at one end of the building. The flooring in one of the toilet floors was stained and it was agreed that it would be replaced. Window blinds have been fitted in some of the internal windows ensuring greater privacy for service users. Fly screens are in place in the external windows. There were twenty single rooms and eight shared rooms, therefore a relatively high proportion of service users share. Where service users share there is screening provided to ensure privacy. The rooms were all comfortable however a number of the single rooms are small, as the home was in operation before the national minimum standards came into place. The home was clean and tidy on the day of the inspection and there were no unpleasant odours. There are hand-washing facilities with liquid soap sited throughout the building and staff reported that they had good access to gloves and aprons. The laundry contains a number of commercial washing machines and the staff member working there, was clear as to the procedures for the handling and washing of foul laundry. Risby Hall Nursing Home DS0000024480.V256477.R01.S.doc Version 5.0 Page 17 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, 29, 30 Service users are protected by the home’s recruitment policies. Staff receive training and support to enable them to do their job however staff sickness and shortfalls in the numbers of staff available can impact on the care that the home provides. EVIDENCE: The levels of staffing on the day of the inspection were satisfactory. The home generally operates with 8 staff in the morning and 5 staff in the afternoon and evening. There are 3 members of staff on duty each night. The home has however experienced some recent staffing difficulties as staff have left and there has been some staff on sickness leave. The inspector was informed by staff, relatives and service users that this had caused some difficulties in that staff were not able to spend time with service users. Staff reported that they sometimes had to rush and didn’t feel that they had time to talk or reassure service users. One service user expressed concern and said that that the staffing shortfalls made them feel very anxious. The inspector was informed that on the previous evening there had been 3 members of staff on duty as two members of staff had rung in sick and the staff on duty had been unable to obtain cover. The inspector was informed that the home does not use agency staff but has its own bank staff. The homes duty rota for the previous month was examined and drop in staffing levels for the previous day appeared to be an isolated incident however there Risby Hall Nursing Home DS0000024480.V256477.R01.S.doc Version 5.0 Page 18 were occasions when the levels of staff had been below the normal staffing levels. A number of staff reported that they were tired and felt under some pressure to work, either on their day off or to work late to cover shortfalls on shifts. Some staff were working long hours, up to fourteen hours in length, and while additional breaks were offered, it was agreed with the manager that this was not always satisfactory. The manager said that staff sickness was being monitored and over the last year had fallen significantly but there had been some recent problems. The inspector was informed that two new staff had been appointed which should help to address the situation. Staff breaks were raised with the inspector as a separate issue and some concern was expressed that after lunch the numbers of staff available to assist service users drop significantly with staff on breaks and in the handover meeting. The inspector was informed that service users had to wait for assistance to be assisted to the toilet. This was discussed with the manager who said that staff working between 8am and 6pm, usually have an hour break at lunchtime, going off in ten-minute intervals. The staff starting work at 1pm provide cover. The staff rota showed that there was a differing number of staff starting work at 1pm and therefore available to cover each day. Despite the issues raised regarding staffing shortfalls, all the service users and relatives were full of praise for the staff who they described as excellent and dedicated. Overwhelmingly service users felt that they were well looked after, and nothing was too much trouble for the staff. The home employs staff from a number of countries including South Africa and the Philippines. The staff general knowledge of the English language and accents was good however some concerns about communication was expressed to the inspector. The home does not currently provide additional language training for its staff as they expect all staff to pass a basic language test. The staff recruitment files seen showed evidence that recently employed staff had received the appropriate checks prior to starting their job. Staff reported that they had good access to in house training and there was evidence of regular and ongoing sessions on a range of subjects, which includes moving and handling, fire, abuse, first aid, working with service users with dementia and infection control. The training on offer is open to both nursing and care staff. Only three members of care staff however have obtained an National Vocational Qualification (NVQ) 2 in care. The manager said that this was because of the number of newly appointed staff but that 12 Risby Hall Nursing Home DS0000024480.V256477.R01.S.doc Version 5.0 Page 19 staff had started the Topps foundation training. Once this had been completed staff would have access to NVQ 2. Risby Hall Nursing Home DS0000024480.V256477.R01.S.doc Version 5.0 Page 20 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, 38 The manager provides clear leadership and service users can expect that their welfare will be protected and their interests safeguarded by the record keeping policies of the home. EVIDENCE: The manager was registered with the Commission shortly before the inspection. The home is currently without a deputy manager and the inspector was informed that efforts are being made to recruit to this post. Staff reported that the manager was approachable and they said that they were able to raise any concerns with her directly. There was evidence that staff receive regular supervision and the home’s written procedures have recently been updated and bound into two booklets for ease of use for staff. Risby Hall Nursing Home DS0000024480.V256477.R01.S.doc Version 5.0 Page 21 The manager has a number of systems in place to monitor and audit the home’s performance. The home also has a quality assurance system and questionnaires are given to Service users and their relatives on a regular basis to complete. The findings are then incorporated in to a report and the manager responds outlining what actions will to taken to address the matters identified. This report is put on display for interested parties to read. Service users had been informed about the announced inspection and the last inspection report was on display. As outlined earlier in the report staff receive training on a range of areas including infection control, fire safety, first aid and moving and handling. The manager confirmed in the pre-inspection information that the homes electrics and gas installation were being checked within the required timescales. The inspector was informed that portable electrical items brought in by service users were checked as part of the admission procedures. The Fire Officer and the Environmental Health Officer have each inspected the home within the last year. The Environmental Health officer made one recommendation, which the manager confirmed had been addressed. The home had won an award for its Food Hygiene practices. Risby Hall Nursing Home DS0000024480.V256477.R01.S.doc Version 5.0 Page 22 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 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 Score X X 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X 3 X X 3 3 X X 3 STAFFING Standard No Score 27 2 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X X X X 3 Risby Hall Nursing Home DS0000024480.V256477.R01.S.doc Version 5.0 Page 23 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 OP27 Regulation 18 Requirement Timescale for action 20/10/05 2 OP27 18 The home’s management must review the arrangements for staff breaks/ handovers to ensure that there is adequate numbers of staff to support service users. The home’s management must 20/10/05 ensure that there are adequate numbers of staff on duty at all times and there are clear arrangements to provide cover in the event of staff sickness. 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 2 Refer to Standard OP30 OP21 Good Practice Recommendations It is recommended that the home management assists staff to develop their communication skills. It is recommended that the home look at developing alternative storage for commodes. Risby Hall Nursing Home DS0000024480.V256477.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ 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 Risby Hall Nursing Home DS0000024480.V256477.R01.S.doc Version 5.0 Page 25 - 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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