Inspection on 07/09/07 for Risby Park Nursing Home

This inspection was carried out on 7th September 2007.

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 Park Nursing Home 19/09/06

Risby Park Nursing Home 19/01/06

Risby Park Nursing Home 07/11/05

Risby Park Nursing Home 21/10/04

Risby Park Nursing Home 14/07/04

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 Park Nursing Home Hall Lane Risby Bury St Edmunds Suffolk IP28 6RS Lead Inspector Jane Offord Key Unannounced Inspection 7th September 2007 09:00 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 DS0000024481.V350850.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. DS0000024481.V350850.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Risby Park Nursing Home Address Hall Lane Risby Bury St Edmunds Suffolk IP28 6RS 01284 811921 01284 811950 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 vacant post Care Home 54 Category(ies) of Dementia - over 65 years of age (12), Old age, registration, with number not falling within any other category (54), of places Physical disability (12) DS0000024481.V350850.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 19th September 2006 Brief Description of the Service: Risby Park was first registered in 1997 and currently operates as a care home providing nursing care for 54 service users. The home is situated in Risby village West Suffolk and is adjacent to Risby Hall Nursing Home, which is also owned by the same proprietors, Risby Hall Nursing Homes Limited. The accommodation at Risby Park is on two floors and there is level access throughout the home with 2 shaft lifts connecting the ground and first floors. The facilities were purpose built and include 46 single ensuite rooms, and 4 double ensuite rooms, which can be used as single rooms or by couples. The accommodation is of a high standard and there is a variety of day and quiet rooms and a conservatory. The home overlooks pleasant gardens and farmland. The home registration has recently been changed to allow the home to accommodate up to 12 service users with Dementia, within the main body of the home. The current weekly fees range between £580.00 and £680.00 depending on the accommodation and the dependency of the resident. The fees do not include toiletries, chiropody, hairdressing, clothing and newspapers. DS0000024481.V350850.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 the core standards for care of older people took place on a weekday between 9.30 and 16.00. The home does not have a registered manager in post at the present time but one of the deputy managers was present throughout the day and assisted with the inspection process by providing files, information and access to the computerised care planning system. This report has been compiled using information available prior to the inspection and evidence found on the day. The files of three newly admitted residents were seen together with their care plans and daily records. A number of maintenance records, the policy folder, menus, the complaints log and quality assurance (QA) results were also looked at. Part of a medication administration round was followed and the medication administration records (MAR sheets) were inspected. A tour of the home was done and most areas revisited later in the day. A number of residents, visitors and staff were spoken with in the course of the day. Prior to this inspection CSCI received a completed annual quality assurance assessment (AQAA) and this also forms part of the information used in this report. Residents were using all areas of the home and looked cared for and relaxed. With the exception of one particular place on the upstairs landing there were no unpleasant odours in the home. Visitors came and went during the day and staff greeted them warmly. Care practice observed was friendly and appropriately performed. What the service does well: What has improved since the last inspection? Greater attention to detail has been paid around the meals served to residents who choose to eat in their rooms. Trays now have a napkin and drink included as routine. DS0000024481.V350850.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. DS0000024481.V350850.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000024481.V350850.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 6. Quality in this outcome area is good. People who use this service can expect to have sufficient information about the service to make an informed choice and have an assessment of need before they enter the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Risby Park and Risby Hall, which is a sister home on the same grounds owned by the same company, have a joint service users’ guide that is informative and was updated in July 2007. The statement of purpose for Risby Park was also recently updated and contains all the information required by standard 1 of the national minimum standards (NMS) for care homes. Both documents are available in the entrance of the home. In addition all new residents receive a welcome pack on arrival containing detailed information about the service offered and including the complaints policy. DS0000024481.V350850.R01.S.doc Version 5.2 Page 9 Three new residents’ files were seen and each contained a pre-admission assessment of need. The assessments covered mobility, continence, personal hygiene, nutrition, hearing and sight, skin integrity, oral care and dressing. Information about social and leisure pursuits was recorded together with past medical history, any known allergies and the mental state of the person. There was no space on the form for signing or dating it so it was not clear when the assessment had taken place or whether a competent person completed it. DS0000024481.V350850.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10. Quality in this outcome area is good. People who use this service can expect to have a plan of care and be protected by the medication practice. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has used computerised care plans for the last eight months and staff spoken with have gradually become competent on the computer and find the system works well. The care plans are printed off if changes are made and a copy is kept in each resident’s room for ownership and ease of reference for carers. The care plans are generated from an assessment undertaken by the named nurse or key worker when the resident is admitted to the home. The assessment and risk assessments are all kept on the computer record. Risk assessments for individuals included moving and handling, falls and maintaining a safe environment. There was evidence that the care plans are reviewed at least monthly or more often if changes occur to the needs or health of the resident. DS0000024481.V350850.R01.S.doc Version 5.2 Page 11 The care plans seen included interventions for supporting the residents with daily activities such as personal hygiene, dressing and undressing, mobility, communication, night care and psychological state. One intervention for a resident relating to their night time routine said, ‘likes the light off and curtains closed’. Another recorded that the resident, ‘misses her family’ under psychological needs. One for dressing said, ‘allow XXXX time to choose her jewellery for the day’. The records contained contact details of any health professional involved in the care of the resident such as GP, dentist and chiropodist. There was a record of appointments with health workers and details of any treatment or changes prescribed. The home has weekly visits from a physiotherapist and a chiropodist attends regularly. Daily records are kept on the computer and completed by trained nurses and carers to give a good picture of the residents’ daily experience of the service. Staff were observed knocking on doors prior to entering rooms and residents’ needs were met in a professional and caring manner. Interactions between staff and residents were friendly and appropriate. Residents spoken with said the staff were always helpful and willing, ‘nothing is too much trouble for them’. Part of a medication administration round was followed and the MAR sheets were inspected. The home uses a monitored dosage system (MDS) for medication so tablets are dispensed into blister packs by a local pharmacist according to the individual prescriptions, for the nurse to administer. There were a few signature gaps noted on the MAR sheets and when a prescription gave a choice of dose i.e. one tablet or two, 5 mls or 10 mls the amount given was not always recorded making an audit trail impossible. During the round it was noted that the MAR sheets had identification photographs with them and that the nurse locked the trolley each time they left it to administer medicines to a resident. The nurse correctly disposed of a dropped tablet. A check was made on the controlled drugs (CDs) and the random count of some stock tallied with the CD register. DS0000024481.V350850.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15. Quality in this outcome area is good. People who use this service can expect to be encouraged to maintain contact with family and friends and be offered a balanced diet. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Each resident’s file seen contained contact details of their next of kin and people important to them. The home has an open visiting policy and a number of people were seen to come and go during the day. Some visitors were present during lunch and helped their relative with their meal. The home has sufficient seating areas for residents to meet with visitors in private but not in their bedrooms if they prefer not to. There is a team of four activities co-ordinators who work between Risby Park and Risby Hall. Residents from either home can attend activities taking place in the other home, which increases the social contact available for them. On the day of inspection only one co-ordinator was on duty and they were seen playing Scrabble with one resident and later helping a group of residents to benefit from the sunny afternoon sitting in the garden. DS0000024481.V350850.R01.S.doc Version 5.2 Page 13 The home has a room on the first floor designated as an activities room that is available to any resident for craftwork or painting. Contact has been established with the local primary school and some children visit regularly to help with activities. The activities co-ordinator said the next project was to make a very large Advent calendar in preparation for December. Last year a calendar had been produced with photographs each month of residents doing activities such as flower arranging, making cards, having a physiotherapy session, painting garden pots with the children and, for December, a visit from Father Christmas. The calendar was sold to raise money for further activity supplies. Access to some parts of the garden has been improved with a paved path that is wheelchair accessible. The deputy manager said the home has achieved a grant to further improve the gardens and plan to incorporate some raised flowerbeds so residents can help with the planting. The home has access to a minibus for outings and a number of these are undertaken throughout the year. There is an informative newsletter called ‘Park Bench’ that details the outings taken and planned as well as seasonal events and birthday celebrations. The menus were seen and showed that residents had a choice of two main courses each day such as mince beef cobbler or corned beef hash with potatoes and fresh vegetables. In addition salad, jacket potatoes or an omelette were always offered as well. Teatime offered a snack such as a pork pie with salad or some soup with a choice of cakes, yoghurts, bread and butter or fresh fruit. The lunch on the day was fish and chips served individually and looked appetising. People spoken with said they had enjoyed it. DS0000024481.V350850.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18. Quality in this outcome area is good. People who use this service can expect to have concerns taken seriously and be protected from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a robust complaints policy that is on display in the entrance hall and available in the service users guide and welcome pack given to each new resident. The complaints log was seen and contained four complaints made this year, two of them from the same relative. One complaint related to restricting enquiries about residents from relatives during the times medication was being administered and the other three were about care issues. All complaints had evidence of being fully investigated and responded to with some changes to practice as a result of findings. The protection of vulnerable adults (POVA) policy was seen and offers full guidance if anyone has concerns. The home also has a whistle blowing policy to protect staff who raise issues. Records showed that POVA instruction is included in induction for all new staff and updated at intervals afterwards. Care and ancillary staff spoken with confirmed they had had POVA training and were clear about their duty of care towards residents. Senior staff in the home are aware of the new Mental Capacity Act and the possible impact it may have on their service. They are planning sessions to raise awareness among staff. DS0000024481.V350850.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26. Quality in this outcome area is good. People who use this service can expect to live in a comfortable, well maintained home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home was purpose built and the accommodation is over two floors that are linked by two passenger lifts. There are forty-six single rooms and four double rooms all with en suite facilities. The double rooms can be used for couples or as particularly large single rooms. There is a rolling programme of redecoration for the whole home using colours that enhance the airy feel of the building. Most rooms overlook the gardens and surrounding farmland. A large circular conservatory on the ground floor has views of the patio area and a pond that is home to some ducks and moorhens. DS0000024481.V350850.R01.S.doc Version 5.2 Page 16 A tour of the home was undertaken with the deputy manager and looked clean. An odour of urine was noted upstairs near the room of one resident. This was raised with the housekeeper who said they try to regularly shampoo that carpet but was aware it was still an issue. Both floors have a kitchenette facility for keeping cold drinks and making hot ones. This is available to residents and visitors. The refrigerators used for milk storage in these areas were not having the temperatures monitored to ensure they were functioning within safe limits for food storage. The infection control policy was seen and offered good guidance on how to prevent cross infection. Soiled linen is placed in disposable alginate bags that are put into the washing machine on a sluice wash after all the other washing has been done. On a visit to the laundry the laundry worker demonstrated that they had just done that. The home has purchased a new industrial washing machine in the last year. The laundry has access to the gardens and sometimes clothing is dried outside rather than using the tumble dryer. DS0000024481.V350850.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30. Quality in this outcome area is good. People who use this service can expect to be supported by correctly recruited and trained staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The duty rotas were seen and showed that on an early shift there were three or four trained nurses and the numbers made up to eleven or twelve staff with carers. During the rest of the twenty-four hours there was always at least one trained nurse on duty. The number of domestics varies between one and four. There was only one on duty on the day of inspection as someone had gone sick and the housekeeping manager could not cover the shift at short notice. There is a team assistant to support the care team with responsibilities for any job that does not involve personal care, so stocking equipment and giving out drinks and meals form part of their role. Three new staff files were seen and all contained evidence that identification checks had been made and a full work history obtained. Each file had a POVA 1st done before the member of staff commenced in post and a criminal records bureau (CRB) check was made within the first couple of weeks of work. New staff shadow more experienced staff for the first two weeks of induction. All the files had evidence that two references had been taken up. DS0000024481.V350850.R01.S.doc Version 5.2 Page 18 Training records showed that this year staff had had sessions in moving and handling, fire awareness, care planning, wound care, infection control, first aid and dementia care. Staff spoken with confirmed that training is ongoing and that training needs are identified during supervision. The numbers of carers with an NVQ level 2 continues to increase with fourteen of twenty-nine now holding the award and a further person completing the course. DS0000024481.V350850.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38. Quality in this outcome area is good. People who use this service can expect to be consulted about the service and have their welfare protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home does not have a registered manager in post at the present time but the senior team is strong with two deputy managers and an assistant deputy manager. There has recently been a head of housekeeping appointed to manage some of the ancillary staff and the home’s owners and management team are based in offices in the grounds and available on a daily basis. DS0000024481.V350850.R01.S.doc Version 5.2 Page 20 Residents’ opinions and suggestions are regularly sought at residents’ meetings and through an annual quality assurance (QA) survey. The last survey was in April 2007 and the results are available for people to access. The survey covered care, hotel service, maintenance issues, meals, the environment and activities. The minutes for the last residents and relatives meeting were seen and showed that a wide range of subjects were discuss and actioned. Shift times were adjusted so some staff begin work at 7am so people who like to be up early can have that choice. A garden party was planned for the summer and a request was made by residents for the purchase of some bird tables and feeders. The activities team took on responsibility to keep a supply of seed and nuts. Changes to the menus were discussed and some of the activities available during the daytime. The home does not manage any personal monies for residents. Any items supplied by the home that is not covered by the fees are invoiced to the resident or their representative. A locked drawer is made available to any resident who wishes for the security of one in their room. A number of service and maintenance certificates were seen and showed that a gas safety check had been completed in July 2007 and the lifts had been serviced the same month. Fire alarms and fire doors had been tested in August 2007 and all the hoists checked in June 2007. A pest control company visits the home monthly to check the grounds and recently destroyed two wasp nests. Temperatures of the refrigerators and freezers in the kitchen are monitored and recorded three times a day. DS0000024481.V350850.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 DS0000024481.V350850.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? NO. STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13 (2) Requirement Timescale for action 07/09/07 2. OP26 16 (2) (k) 3. OP38 13 (4) (c) The MAR sheets must be completed correctly when medication is dispensed to ensure residents receive the medicines as they have been prescribed. Steps must be taken to eradicate 07/09/07 all unpleasant odours in the home so the residents live in a pleasant environment. The temperatures of all 07/09/07 refrigerators used to store food must be monitored to ensure they are functioning at a safe level for storage of food to protect residents. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations DS0000024481.V350850.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Colchester Local Office Fairfax House Causton Road Colchester Essex CO1 1RJ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI DS0000024481.V350850.R01.S.doc Version 5.2 Page 24 - 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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