CARE HOMES FOR OLDER PEOPLE
Risby Hall Nursing Home Hall Lane Risby Bury St Edmunds Suffolk IP28 6RS Lead Inspector
Cecilia McKillop Key Unannounced Inspection 7th September 2006 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.V311146.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. Risby Hall Nursing Home DS0000024480.V311146.R01.S.doc Version 5.2 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 34 Category(ies) of Dementia - over 65 years of age (34), Old age, registration, with number not falling within any other category (34), of places Physical disability (4) Risby Hall Nursing Home DS0000024480.V311146.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 3rd October 2005 Brief Description of the Service: Risby Hall is a care home for older people providing nursing care and 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 7 shared rooms. The home registration has recently been changed to allow the home to accommodate service users with Dementia and it has been agreed that one of the double bedrooms will be made into a second lounge. The home can accommodate 34 service users and the weekly fees range from £359 to £580. Risby Park, which is also a care home for older people, is located adjacent to Risby Hall. Risby Hall Nursing Home DS0000024480.V311146.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This key unannounced inspection, looking at all the core standards for care of Older People, took place on a weekday between 10am and 4.30pm. The manager Mrs Yvonne Ball assisted the inspector throughout the day. The care plans and daily records of three residents were seen. The file of a newly appointed staff member, the staff training programmes, staff supervision records, the duty rotas and some quality assurance records were examined. A tour of the home was undertaken, and part of a medication administration round was observed. A number of residents, visitors and staff were spoken with in the course of the day. Care practice was observed and training was discussed with some staff. The kitchen and laundry were both visited and the lunchtime meal serving was seen. There were 31 service users in residence on the day of the inspection and the manager confirmed that 10 service users had a diagnosis of dementia, although the home was caring for an additional number of service users who were exhibiting some confusion. What the service does well:
Risby Hall is friendly home where staff make efforts to make the service users feel at home. Service users spoke very highly about the commitment and kindness of staff. Service users were observed being treated in a warm, respectful and appropriate manner. The home provides good range of activities on offer including cookery, aromatherapy and physiotherapy. The majority of activities are on a group basis but the activity organiser also spends individual time with service users, who are in bed, doing activities such as manicures or reading. Trips put have been organised in the new minibus, which the home shares with the other homes in the group. Regular newsletters are produced to update service users on changes to the home and forthcoming events. Contributions from service users are also included. There are sound monitoring systems in place and the manager undertakes regular audits to ascertain that the standards are being met and care is being delivered. A customer satisfaction survey is also undertaken to ascertain service users and relative’s views of the care. A summary report on the findings and actions that the manager intends to take to address the shortfalls identified is prepared and displayed.
Risby Hall Nursing Home DS0000024480.V311146.R01.S.doc Version 5.2 Page 6 There are sound systems in place for the recruitment of staff and staff have access to a good range of training opportunities. What has improved since the last inspection? What they could do better:
The accommodation provided is of an adequate standard but some of the rooms are compact and a relatively high proportion of service users share, although this complies with the standards as the home was registered before 2002. One double bedroom has been decommissioned and it is planned that this will be turned into a second lounge increasing the choice of communal space for service users. On the day of the inspection this was awaiting redecoration. Unfortunately one window looks out into the corridor and the other window has obscured glass and is above head height. It has been recommended that the home replace this window to enable service users using this room to have a more interesting outlook. Risby Hall Nursing Home DS0000024480.V311146.R01.S.doc Version 5.2 Page 7 The laundry was in need of deep cleaning and some re organisation of the storage. Where net underwear are being used they must be labelled and used by the named service users only. Liquid soap should be available in all the bathrooms and the type of lock used on the visitor’s toilet must be reviewed in the light of the changed admission policy. 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.V311146.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Risby Hall Nursing Home DS0000024480.V311146.R01.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5 Quality for this outcome area was good. People who use this service can expect to be provided with information about the home, have their needs assessed and assurances given that they can be met prior to entering the home. EVIDENCE: The home has a statement of purpose, which has been amended to take account of the fact that the home now cares for service users with a diagnosis of Dementia. There was evidence in the service users meetings of some discussions with existing service users about this change. Additional training has been provided to care and nursing staff and the manager confirmed that further training is planned. One of the positive developments at the home has been the creation of an personalised folder for service users containing key documentation about the home such as the statement of purpose, staff list, information about the local surgeries and details about the homes complaints procedure. Risby Hall Nursing Home DS0000024480.V311146.R01.S.doc Version 5.2 Page 10 The records on two newly admitted service users were examined and there was evidence of a comprehensive assessment being undertaken prior to their admission. Families and service users are encouraged to visit and look around the home prior to an admission. Terms and Conditions of residence are provided to service users in a written form. The home does not offer intermediate care. Risby Hall Nursing Home DS0000024480.V311146.R01.S.doc Version 5.2 Page 11 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 for this outcome area is good. People who use this service can be assured that their care plan covers their assessed needs that the medication administration procedures will protect them and they will be treated with respect. EVIDENCE: The care plans for three 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. The inspector spoke with a visiting health professional on the day of the inspection who confirmed that the service user who they had visited had made significant progress since their admission from hospital. Risby Hall Nursing Home DS0000024480.V311146.R01.S.doc Version 5.2 Page 12 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. The commission pharmacist inspected the homes medication systems in October 2005 and the practice was found to be of a good standard. On the day of the inspection staff were observed administering medication and the practice and documentation appeared satisfactory. There were also records in place to confirm that the manager undertakes regular audits of medication records. Service users were appropriately dressed on the day of the inspection. Staff were observed responding to service users in a warm and caring manner and having due regard for their privacy and dignity. Doors were closed when personal care was being provided and screens were available in the sample of double rooms examined. An issue was however identified with the use of “net ”underwear which the inspector noted was not labelled but was being used by a small number of service users. Risby Hall Nursing Home DS0000024480.V311146.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality for this outcome area was good. People who use this service can expect to have access to a good range of activities, a wholesome diet and be enabled to maintain contact with family and friends. EVIDENCE: The home has two activity organisers who provide a good range of activities for service users on a daily basis. Each service users is provided with a monthly programme of in-house activities, which includes crafts, cookery and reminiscence. In addition there are trips out in the new minibus, which the home shares with the other homes in the group. On the day of the inspection however one of the activity organisers was on annual leave and the other was unwell so the programme was not in operation, however staff took some service users to the adjacent home, Risby Park, where entertainment was being provided. The inspector observed relatives being welcomed into the home and one visiting relative said that staff look after them as well as the service user. Staff were observed offering service users choices and there were evidence in the care plans of service users choice and independence being promoted. 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.
Risby Hall Nursing Home DS0000024480.V311146.R01.S.doc Version 5.2 Page 14 The dining tables were attractively laid and the lunch served on the day of the inspection consisted of either braised steak or sausage and onion pie with vegetables. There was a separate pureed meal for service users who required this, however alternatives were also available and one service users who had been unwell was given soup and vegetables. Apples and custard were served for pudding. A number of service users needed help with eating and staff were observed assisting them in a sensitive way. The service users who were interviewed were generally positive about the meals. A positive development since the last inspection has been the introduction of a more substantial supper and service users are now offered sandwiches with their supper drink. The cook was interviewed and the kitchen toured as part of the inspection. There was a list in the kitchen of service users preferences and the cook confirmed that all cakes took account of the needs of diabetics. There were sufficient stores of dried food and the food was appropriately covered however there a significant number of flies in the kitchen despite fly screens being in place. Risby Hall Nursing Home DS0000024480.V311146.R01.S.doc Version 5.2 Page 15 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality for this outcome area is good. People who use this service can expect to find that complaints are taken seriously and service users are protected from abuse. EVIDENCE: The home has a complaints procedure, which is outlined in the welcome pack, and, 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. The manager confirmed that training is provided to staff on the protection of vulnerable adults and updates are provided on a yearly basis. The manager has referred matters of concern over the last year for investigation and has followed matters up appropriately. Service users finances records are maintained from the office in Risby Park but the inspector was informed individual records are maintained that all expenses such as hairdressing and newspapers are invoiced. Risby Hall Nursing Home DS0000024480.V311146.R01.S.doc Version 5.2 Page 16 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): 19,20,21,22,23,24,25,26 Quality for this outcome area is adequate. People who use this service can expect to live in a comfortable environment but have limited choice of communal space. Service users have access to a range of equipment to maximise their independence. EVIDENCE: Risby Hall is located in a small village and the accommodation is converted from what was the farmhouse and outbuildings. The home is all on the ground floor and there is level access throughout. The home was tidy and there were no unpleasant odours. The handyman was working in the building painting and decorating. The homes registration has recently been amended to enable the home to care for service users with Dementia and as a result there has been some changes to the environment. Additional locks and buzzers have been fitted to all external doors and a small enclosed courtyard area has been created. There has also been improvement to the access to the building. It had been agreed that an additional lounge would be created to allow greater choice of seating
Risby Hall Nursing Home DS0000024480.V311146.R01.S.doc Version 5.2 Page 17 areas for service users but this was awaiting re decoration and had not yet been brought into use. The room, which had been identified as a second lounge, had been a double bedroom but had a poor aspect in that the window overlooking the garden was above head height and had obscured glass. There is a large central sitting and dining room were the majority of service users spend their day. The chairs are arranged into small groupings in such a way as to encourage discussion between small groups and appeared to work well. However on the day of the inspection one service user was observed shouting another and a second lounge when fully operational will provide an alternative space for service users. There were twenty single rooms and seven 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 became operational. The toilets are located throughout the building and a number within proximity of the communal areas. The visitor’s toilet had a lock, which could not be overridden in the event of an emergency and given that the home is now catering for service users with dementia they have been required to change this. There are hand-washing facilities with liquid soap sited throughout the building, however the inspector noted that there was none available in the new shower room and it was agreed that this would be addressed. Staff reported that they had good access to gloves and aprons. There was evidence that staff were monitoring water temperatures and the temperature was within the recommended levels on the day of the inspection. 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. The laundry was dusty and cluttered, although efforts were made by staff to address some of the shortfalls before the inspection ended. On the day of the inspection the inspector observed that there were a significant number of flies around the home, although fly screens were in place on windows. The flies were observed in the kitchen and landing on service users. The manager informed the inspector the problem had arisen because the home was located near to a farm and advice had been taken from the environmental health officers about how to reduce the numbers. Risby Hall Nursing Home DS0000024480.V311146.R01.S.doc Version 5.2 Page 18 There was a range of specialist equipment available to assist service users, including hoists, chairs and specialist mattresses. Risby Hall Nursing Home DS0000024480.V311146.R01.S.doc Version 5.2 Page 19 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 The quality outcome for this area is adequate. Service users are protected by the home’s recruitment policies. Staff receive training and support to enable them to do their job. Service users needs are met by adequate numbers of staff. EVIDENCE: On the day of the inspection there were 7 staff on duty in the morning including two nurses and 5 carers. There were 5 staff in the afternoon, of which two were nursing staff. Four carers and one nurse were on duty for the evening shift. There are 3 members of staff on duty each night. In addition ancillary staff were on duty to undertake domestic, laundry and catering duties. The levels of staffing on the day of the inspection were satisfactory in the morning and staff were observed responding appropriately to requests for assistance. The levels of staff reduce in the afternoon and the home is less well covered and bells were noted to ring for longer periods. The inspector was informed that normally the activity organisers supplement staffing in the afternoon but they were unavailable on the day of the inspection because of sickness. Risby Hall Nursing Home DS0000024480.V311146.R01.S.doc Version 5.2 Page 20 Relatives and service users who were interviewed on the day of the inspection spoke highly of the kindness and helpfulness of staff. The interaction, which the inspector observed, was warm and friendly. The staff recruitment files seen showed evidence that recently employed staff had received the appropriate checks prior to starting their job. The manager informed the inspector that newly appointed staff undertake the in-house induction and the Topps certificated training programme. Staff reported that they had good access to in house training and there was evidence of staff receiving regular updates on a range of subjects, which includes moving and handling, fire, abuse, working with service users with dementia and infection control. Training on food hygiene is planned for care staff and training in team management and leadership course for nursing staff. The inspector was informed that 12 staff were undertaking NVQ training, with 3 staff doing NVQ level 3 and 9 staff doing NVQ level 2. Risby Hall Nursing Home DS0000024480.V311146.R01.S.doc Version 5.2 Page 21 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,36,38 Quality for this outcome area was good. The manager provides clear leadership and service users can expect to be consulted about their care and their interests safeguarded by the record keeping policies of the home. EVIDENCE: The manager Mrs Ball was registered in 2005 and is knowledgeable about the needs of older people. Mrs Ball informed the inspector that she was hoping to complete the registered managers award within the next couple of months. As part of the change in the homes registration it has been agreed that Mrs Ball will undertake additional training in the care of service users with Dementia and it is planned that this will commence in the spring of 2007. The deputy manager position remains vacant and the manager confirmed, that efforts continue to recruit to this post.
Risby Hall Nursing Home DS0000024480.V311146.R01.S.doc Version 5.2 Page 22 Staff reported that the manager was approachable and supportive. There was evidence of staff receiving regular supervision. The manager has a number of systems in place to monitor and audit the home’s performance against the standards and good practice. This is an area where the manager should be commended and it was positive to note that areas such as falls, drug administration records and wound care were being closely monitored. The home also has a quality assurance system and questionnaires are given to service users and their relatives on a yearly 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. Residents meetings are held and minuted. 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’s audits address a number of areas relating to the health and wellbeing of service users including the fire alarm tests, the maintenance of hoists and accidents. There was evidence of file of accidents being monitored and efforts being made to reduce the numbers and seriousness of falls. One service user who had fallen a number of times at night was being checked every 15 minutes as a result and the numbers of falls had reduced. The fire officer had recently conducted an inspection of the home and has made a number of requirements. The manager informed the inspector that work was underway to address the matters identified. Risby Hall Nursing Home DS0000024480.V311146.R01.S.doc Version 5.2 Page 23 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 4 N/A 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 2 11 N/A 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 N/A 18 3 2 3 2 3 3 3 3 2 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 4 N/A N/A 3 N/A 3 Risby Hall Nursing Home DS0000024480.V311146.R01.S.doc Version 5.2 Page 24 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 OP21 Regulation 16 Requirement The lock on the door of the visitors toilet should be replaced with a type which could allow access to the room in the event of an accident to a service user. The laundry must be deep cleaned and the storage reviewed. Personal items of clothing such as net knickers must be for the individual use of service users only. Suitable hand washing facilities must be available in all bathrooms. Timescale for action 20/10/06 2. OP26 16 20/10/06 3 OP10 16 20/10/06 4 OP26 16 20/10/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Good Practice Recommendations
DS0000024480.V311146.R01.S.doc Version 5.2 Page 25 Risby Hall Nursing Home 1 Standard OP19 The room which has been identified as a second lounge would benefit from having a window fitted which service users can look out of. Risby Hall Nursing Home DS0000024480.V311146.R01.S.doc Version 5.2 Page 26 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
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