Inspection on 26/04/06 for Rugby Care Centre

This inspection was carried out on 26th April 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Rugby Care Centre 17/04/07

Rugby Care Centre 09/11/05

Rugby Care Centre 06/09/04

Rugby Care Centre 27/04/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Westmead

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

CARE HOMES FOR OLDER PEOPLE Rugby Care Centre 53 Clifton Road Rugby Warwickshire CV21 3QE Lead Inspector Jackie Howe Key Unannounced Inspection 26th April 2006 09:15 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 Rugby Care Centre DS0000004292.V289048.R01.S.doc Version 5.1 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. Rugby Care Centre DS0000004292.V289048.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Rugby Care Centre Address 53 Clifton Road Rugby Warwickshire CV21 3QE 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) 01788 542353 01788 567941 Exceler Healthcare Care Home 29 Category(ies) of Old age, not falling within any other category registration, with number (29) of places Rugby Care Centre DS0000004292.V289048.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 9th November 2005 Brief Description of the Service: Rugby Care Centre is an established care home providing personal care for up to 29 residents. The home is a detached dwelling near to the town centre of Rugby. The main shopping centre is only a few minutes walk from the home. Appropriately trained staff provide the care. Rugby Care Centre admits service users for respite and long term care. The care staff are supported by the benefits of a large well-established organisation. An activities co-ordinator is employed at Rugby Care Centre to provide activities to service users. Accommodation is mainly single room over two floors. Some shared accommodation is available. The home has a large lounge, which looks out over the garden, and a big airy dining room, as well as additional communal space, which can serve a multi purpose. Service users are provided with three meals a day taken in either of the dining rooms or if they choose in their own room. District nurses visit the home to provide nursing care for service users in need of wound care or other nursing needs. Current range of fees: £338 - £417.30 per week. Rugby Care Centre DS0000004292.V289048.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place between 9.15 am and 6.00pm and was undertaken by two inspectors. The commission’s pharmacy inspector visited on another day, and her findings have been included in this report. This was the first inspection of the inspection year 2006/07, and was a key inspection. The inspection included a tour of the home, speaking with residents, visitors and staff, reading care plans and accessing records. The manager was present throughout the day. What the service does well: What has improved since the last inspection? The new owners, Southern Cross Health Care are investing in the home and a refurbishment programme is underway. Residents and visitors are pleased with the changes and feel that the surroundings are being enhanced. Paper work is being reviewed and the Statement of Purpose, and Service User Guide have been re written. Rugby Care Centre DS0000004292.V289048.R01.S.doc Version 5.1 Page 6 Care planning and assessment documentation have been improved. A training programme for staff is now underway and the manager has started to introduce a supervision format in order to more effectively manage the training needs and performance of the staff team. Quality assurance surveys have been undertaken and the manager is hoping to audit these with the intention of providing an action plan and objectives for the home. Recording of risk assessments has improved with new care plan documentation, but residents with old care plans still have not had risk assessments reviewed or updated. 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. Rugby Care Centre DS0000004292.V289048.R01.S.doc Version 5.1 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 Rugby Care Centre DS0000004292.V289048.R01.S.doc Version 5.1 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, 4 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents receive an assessment of their needs prior to entering the home so that they know the home is suitable to meet these needs. EVIDENCE: The initial assessment of a recently admitted resident was reviewed. A copy of the care plan provided by the social worker was evident together with the assessment of the resident’s needs undertaken by the manager. The home had used the new documentation implemented by the company. The pre admission assessment identified and recorded the needs of the individual. The file contained risk assessments for tissue viability, falls, nutrition, moving and handling During the course of the inspection visit it was seen that one resident whose first language is not English was finding it difficult to understand staff and some staff also had difficultly in communicating with the resident. Rugby Care Centre DS0000004292.V289048.R01.S.doc Version 5.1 Page 9 The manager advised that she is liaising with the family and is undertaking a review to ensure the home can meet the resident’s social and spiritual needs. The manager also advised that the chef prepares separates meals ensuring only food appropriate to the residents religious beliefs are served. Some files read, did not contain a social services assessment of need. A care management assessment should always be obtained for social services referred residents so that the staff can make an informed decision as to whether the home is suitable to meet their needs. Inspectors were happy that the home’s new documentation, allows staff to appropriately assess the needs of potential residents and meets the standards required. Rugby Care Centre DS0000004292.V289048.R01.S.doc Version 5.1 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, 10 Quality in this outcome group is adequate. This judgement has been made using available evidence including a visit to the home. Care plans are improving with the introduction of new paper work. Further development is required to ensure that all residents have an individual plan of care, which clearly describes the care they need and fully identifies areas of risk. The home is not fully meeting the health needs of the residents, and without improvement there is the chance that aspects of residents’ care may not be fully attended to. Personal support is offered in such a way to maintain resident’s privacy. Staff, to ensure that all residents are enabled to maintain a level of dignity in their day-to-day lives, should be more person centred in their approach. The level of medicine management within the home has improved. The inspection demonstrated that good systems had been installed to maintain the safety of the service users within the home. EVIDENCE: Rugby Care Centre DS0000004292.V289048.R01.S.doc Version 5.1 Page 11 The care plans of three residents were read in detail with others looked at for items of specific information. The manager and her staff are currently transferring all the care plans into the new format and examples of both systems were read, some care plans still have documents from each format. A new format file of a recently admitted resident was examined in detail. Good practice was noted in the use of risk assessment tools for falls, moving and handling, development of pressure sores and nutrition, but the risk assessments were not cross referenced to the care plans and daily records. For example, the service user had been admitted to the home in March with ‘red skin on sacrum’. The daily records had recorded that the district nurse had asked for cream to be applied to the sore and a pressure-relieving cushion to be provided. The care plan seen for pressure area care directed staff to apply the appropriate cream to the red area, but did not ask staff to ensure an appropriate relieving cushion was provided. It was also noted from daily records, that the district nurse was ‘to look at her today’ because of a pressure sore. There was no evidence in the file that the service user had been assessed as her care plan had not been updated and there were no further entries in the daily records relating to the pressure sore. These omissions could result in an oversight of care for this service user. One lady who has had a recent serious fall had not had her falls risk assessment sufficiently recorded, nor had it been reviewed or updated following her fall. The frequency of night recording and quality of daily records remains poor, and it is evident that training for staff is required in this aspect of care. The health needs of some residents are not being fully met. The manager said that she is trying to organise support from an external dental service and chiropodist. An optician service is used by the home, but one resident reported that whilst he had been assessed for glasses they had not arrived and he was experiencing difficulty watching the television. It is evident from the care plans read, that improvements have been made. Care needs in some have been identified and well documented with use of sensitive language and detailed risk assessment. Work is needed to ensure that all care plans are of the same standard. Rugby Care Centre DS0000004292.V289048.R01.S.doc Version 5.1 Page 12 Throughout the inspection there was evidence of residents being spoken with courteously, but there was also evidence that staff would benefit from further training in person centred and dementia care, to ensure that residents are treated with dignity. Residents were very positive about the care they receive. ‘I think the staff are marvellous, they most definitely give good care’. Relatives confirmed that the staff are competent in their role, and that relatives are ‘well cared for’. Other comments received were: ‘The staff at the home, work very hard. They are always friendly and caring’. ‘The staff are very good, I have never had a necessity to complain’. The pharmacist inspector interviewed staff and one service user and a sample of Medicine Administration Record (MAR) charts were checked to see if the medicines had been administered as the doctor intended and the records supported this. All staff had received three sessions of training from internal and external sources and the level of medicine management within the home had improved considerably. The majority of audits undertaken demonstrated that the medicines had been administered as prescribed in most instances. Only two medicines were found to be incorrectly administered and recorded from a sample audited. One care assistant transported service users medicines to their room in small medicines pots and not in the trolley. This was considered poor practice because in the event of an emergency the medicines could not be safely secured whilst the event is dealt with. This was against the manager’s guidance. Good systems had been installed to check all the service users medicines upon receipt into the home regardless of their source whether they are bought in from home, hospital or sent from the local pharmacy. Hand written MAR charts were well written and all had been checked by an additional member of staff. One senior care assistant was interviewed during the inspection, and demonstrated exceptional knowledge in the reasons why medicines were prescribed and administered and this was commended. The home had purchased a book for current medicine information for all staff to read. Service users are encouraged to self administer their own medicines but one service user’s inhalers were not recorded on the MAR chart nor were any compliance checks undertaken to see if she could take them correctly. Rugby Care Centre DS0000004292.V289048.R01.S.doc Version 5.1 Page 13 The service user said that she was in pain during the night and one inhaler was almost empty. Staff had already made contact with the doctor to seek an additional prescription to treat her pain. An additional inhaler was to be requested. All creams and external preparations were kept in a locked cabinet in the service users rooms and an additional MAR chart was provided for the care assistants to record their use. All creams were dated once opened and their use reviewed on a regular basis. Audits found that all the Controlled Drugs on the premise had been accurately recorded and the MAR chart entries matched those in the CD register. This demonstrated good practice. A new CD cabinet was on order to replace the existing one. The manager undertakes a variety of regular audits to demonstrate the medicines are administered as prescribed and this is commended. Medicine management within the home had been raised to a safe level and staff are aware of the importance of good practice. Rugby Care Centre DS0000004292.V289048.R01.S.doc Version 5.1 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 15 Quality in this outcome group is good. This judgement has been made using available evidence including a visit to the home. Daily living and social activities are flexible and varied to suit service users expectations and preferences. There is a nutritious and varied choice of meals offered to residents. EVIDENCE: The home has an open visiting policy; one relative spoken with confirmed that visitors could visit the home ‘whenever we want’. Residents were observed to receive visitors in the communal areas and in the privacy of their own rooms. A four weekly social and leisure activities schedule has been produced. Activities listed included bingo, pamper days, gardening club, reminiscence therapy, painting, music, ‘sing-along’ and birthday celebrations. There are church services or visits provided three times a week. Photographs of recent activities enjoyed by residents were displayed on the residents’ notice board. A record of activities participated in was not evident in the care files of residents, although specific paperwork is provided for this purpose. Rugby Care Centre DS0000004292.V289048.R01.S.doc Version 5.1 Page 15 The manager said that an activities organiser has been appointed and she will start as soon as satisfactory pre-employment checks have been received by the home. There was no planned activity taking place during the time of inspection, but there was evidence of games and books available. A visitor spoken with confirmed that his relative was invited to attend activity sessions but often declined, preferring to spend time in her room and staff respected this decision. The inspector observed meals service to residents who prefer to stay in the lounge. The menu displayed in the lounge was incorrect, and residents spoken with were unaware of what was on offer or what to do if they didn’t like the menu, although spoke very highly of the quality of the food. ‘I haven’t got a clue what is for lunch, it will be a nice surprise’. ‘The food is very nice, couldn’t get any better and there is always plenty to eat. Not sure if you can get something different – often wondered that myself’. ‘ You don’t choose your lunch, they just bring it’. One resident who received a soft diet said the food was very tasty but she had no idea what it was as every meal looked the same. Residents sat at very low tables and some struggled to eat their meal in a comfortable position. Staff need to receive further training and guidance in caring for people with dementia at meal times. One lady with a diagnosis of dementia was given a tray with cutlery 15 minutes before her meal, which resulted in her playing with her cutlery and putting it in her mouth, which did not aid her dignity. Her meal was eventually brought to her and she was assisted at an appropriate pace. Whilst residents were offered a choice of drinks, some residents were given drinks in plastic beakers. Staff said this was because there were insufficient glasses. Whilst for some residents a risk assessment may indicate that plastic beakers are less of a risk, for others it may not be age appropriate. Relatives spoke highly of the food provided by the home, and of the effort made on special days such as Christmas and birthdays. Rugby Care Centre DS0000004292.V289048.R01.S.doc Version 5.1 Page 16 ‘The food is excellent, plenty of choices. Christmas dinner was lovely. Mum has eaten like a Trojan since being here, prior to admission she was not eating or drinking at all well’. An inspector visited the kitchen before the evening meal and talked to the cook. The kitchen was clean and well organised and there was ample food in the fridges, freezers and dry food stock. Menus for a four-week period were examined, and were seen to offer a varied diet. Records of cleaning schedules, food temperatures and fridge and freezer temperatures were maintained. The Environmental Health Officer had visited on 03/08/05 and had recorded “very good standards observed.” Rugby Care Centre DS0000004292.V289048.R01.S.doc Version 5.1 Page 17 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 The judgment for this outcome group is poor. This judgement has been made using available evidence including a visit to the home. The system for the recording of complaints is limited. The absence of clear procedures combined with a lack of staff training in issues of protection could place residents at risk of abuse, whether deliberate or through negligence or ignorance. EVIDENCE: The home has a procedure for handling complaints this needs to be reviewed to ensure that all the information detailed in the document is accurate, as the home has recently changed ownership. The procedure is available and accessible to residents, staff and visitors in the home. The complaints file was examined. There was one complaint recorded in the file, although there was no follow up entry in this book to indicate that the complaint had been resolved. When questioned, the manager was aware of this complaint and advised that she had written to the complainant but was unable to produce evidence that the complaint had been appropriately investigated and that the complainant was satisfied with the outcome. During discussion a relative confirmed that he would speak with the manager if he had any concerns. He also said that any ‘niggles’ he had raised with the manager had been dealt with appropriately and he was ‘confident she would sort out any concerns’ the family may have about their relative’s care. Rugby Care Centre DS0000004292.V289048.R01.S.doc Version 5.1 Page 18 Adult Protection training remains outstanding for some members of staff. Evidence was seen that training has been arranged and training records will be examined in full at the next inspection visit. The company provides in-house training of staff. Nine members of staff have had training in recognition and prevention of adult abuse since January 2006. The course content was examined and it is important that the manager ensures her staff are fully aware of all aspects of this training during supervision. Training for a further four members of staff has yet to be arranged. A copy of the multi agency adult protection policy for Warwickshire was seen. The home’s policy was not available and was not found until the end of inspection visit. The manger advised that she is in the process of updating the home’s abuse policy since taking up her post. A procedure for responding to allegations of abuse should be readily available with clear guidance for staff to follow ensuring they know their responsibilities for reporting to senior staff within the organisation. Since the last inspection there have been a recent adult protection issue that the manager appropriately brought to the attention of Social Services, the Commission for Social Care Inspection and relatives. Appropriate actions were taken to reduce any subsequent risks to residents. Rugby Care Centre DS0000004292.V289048.R01.S.doc Version 5.1 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 Quality in this outcome group is adequate. This judgement has been made using available evidence including a visit to the home. The standard of décor and furnishings has improved, with evidence of ongoing planned refurbishment and maintenance. EVIDENCE: The home is subject to an ongoing refurbishment programme and at the time of inspection there were decorators in the home working in a communal lounge. This in itself presents some risks to residents as there are decorating materials and equipment in the home as well as dust which is generated as they work. This was being managed well by the manager. Those areas of the home, which have been decorated, have been done to a satisfactory standard. New furniture, carpets and soft furnishings have been provided in rooms as well as some new light fittings. Rugby Care Centre DS0000004292.V289048.R01.S.doc Version 5.1 Page 20 There are still areas of the home to be completed and the manager advised that bedrooms will be decorated as they become vacant. The laundry room was seen to be well ordered and tidy and suitable bags are available at the home for transporting soiled laundry to the laundry room. The wash hand basin was accessible and there was protective clothing available. Laundry is undertaken by ancillary staff who also iron and fold the clean clothing. A number of clean woollen garments hanging in the laundry were badly wrinkled and appeared to have been washed on too high a temperature. Cleaning items were not being stored safely in accordance with COSHH regulations (Control of Substances Hazardous to Health). The COSHH cupboard containing large quantities of cleaning substances was unlocked. As the laundry door was also unlocked this potentially places residents at risk. Rugby Care Centre DS0000004292.V289048.R01.S.doc Version 5.1 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome group is adequate. This judgement has been made using available evidence including a visit to the home. Systems in the home have improved in regard to training and recruitment of staff. The number of staff employed is sufficient to meet the needs of the current residents living in the home. Duty rotas do not accurately record the hours worked by care and ancillary staff. EVIDENCE: Concerns were raised on cards received prior to the inspection about the staffing levels in the home, and hours worked by staff. ‘ The home seems to be understaffed and they work very long hours.’ ‘ No allocated carer per resident, I have concerns about levels of staff training’. Staffing rotas were examined for the past 4 weeks. Staffing levels for the home are three care staff on from 7.30am – 2.30pm and 2.30 – 9.30 and two waking staff at night. Care staff are supported by domestic staff who also work in the laundry, kitchen staff who are currently employed by an outside agency, and administration support. The activities organiser post has been vacant for since last September, but the manager said that she hoped this post would be filled by early May. Rugby Care Centre DS0000004292.V289048.R01.S.doc Version 5.1 Page 22 The manager is also employing an acting care manager. On the day of the inspection there were only eighteen residents in the home. Staff were observed to have sufficient time to offer a care and the atmosphere in the home was calm and unhurried. The manager needs to ensure that as the home fills to its maximum occupancy that staffing levels continue to meet resident’s needs. The staffing rota does not currently reflect the actual hours worked by staff so that it is not easy to see who is on duty at any set time. This was discussed with the manager and a requirement has been made. The manager has been successful in recruiting new care staff and there has been no agency usage in the home over the past few months. Three staff files were read. Recruitment procedures were found to be thorough and all files held copies of 2 written references, and CRB checks had been undertaken. Staff confirmed that they had received a copy of the GSCC code of conduct. The home currently employs a number of overseas staff who hold nursing qualifications gained in their own country of origin. A number of staff have now been enrolled, but are yet to start, on a course to obtain NVQ level 2 in care, and two staff will undertake their NVQ level 3. Training undertaken has been predominately ‘in house’ as supplied by Southern Cross. Training courses undertaken by staff in April included Administration of Medication, Protection of Vulnerable Adults (POVA), Fire Safety and Basic Food Hygiene. 3 staff have attended training in care planning. The Health and Safety training had to be rescheduled and the manager is waiting a new date. Dementia care training provided by in house trainers, has been attended by some staff, but practices observed indicate that more is needed to ensure consistent good practice and that staff are up to date with new methods and offering a person centred approach to care. The manager has experience in working with people with dementia and the staff will benefit from closer supervision and support in this area. Information and training can also be obtained from the Alzheimer’s society. Rugby Care Centre DS0000004292.V289048.R01.S.doc Version 5.1 Page 23 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, 35, 36, 38 Quality in this outcome group is good. This judgement has been made using available evidence including a visit to the home. The new manager is having a positive impact in the home, operating each shift with clear leadership and direction, quality management systems in this home are developing, with evidence that residents’ views are being sought and acted upon. A suitable system for staff supervision is being implemented to ensure that staff have the support, skills, practices and knowledge to meet all of the resident’s needs. Rugby Care Centre DS0000004292.V289048.R01.S.doc Version 5.1 Page 24 EVIDENCE: The home has been through a rather unsettled period over the past few years and has had a number of different managers. This has had a negative impact especially in the staff that have felt a lack of clear guidance. The new manager took up her post in January 2006. Her management style is proactive and she shows a commitment to change and improvement. It is her first manager’s post and she is yet to be registered by the commission. Comments received from residents, visitors and staff are positive. ‘ The manager is very pleasant and helpful and is definitely bringing about positive changes’. ‘ The manager is very good to deal with, there have been a lot of changes and you can really see the difference’. ‘The new manager is very thorough, I hope she stays’. Staff confirmed that the manager is bringing about necessary change and that things had improved. Staff meetings are now regularly being held, where things are openly discussed and staff find these productive. Residents / relative meetings have also taken place. Relatives spoke about these meetings and said that staff were willing to accept ‘constructive criticism’ and ‘ comments made are responded to positively’. Systems for the management of residents’ finances ensure that their interests are safeguarded. Two recent positive comments were seen from appreciative relatives in the comments/complaints book kept in the entrance hall. Comments seen included “home is very nice looking, much improvement, resident says is happy here.” and “home is pleasant and sweet smelling” A range of records relating to health and safety matters were examined. These included portable applicance tests (PAT), electrical safety, gas safety records, pest control contract, nurse call system, service of the lift and fire safety records. The manager was asked to forward confirmation that the recommendations raised in the lift report dated 13/12/05 have been underaken. No concerns regarding the health and safety of the home were identified during this inspection. Rugby Care Centre DS0000004292.V289048.R01.S.doc Version 5.1 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 2 2 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 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 2 17 X 18 2 3 X X X X X X 2 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 x 3 2 x 2 Rugby Care Centre DS0000004292.V289048.R01.S.doc Version 5.1 Page 26 Are there any outstanding requirements from the last inspection? yes 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 OP3 Regulation 14 Requirement Timescale for action 30/06/06 2. OP4 12 3. OP7 17 4. OP8 13 The manager must ensure that a full pre assessment of needs is conducted and recorded prior to admission to demonstrate that the assessed needs of a prospective resident can be met by the home. The home should proceed to use the new care plans that have been expanded to include a greater range of care needs, including foot care, personal safety, pressure area care, damaged and ulcerated skin care. The manager must be able to 30/06/06 demonstrate the homes capacity to meet the assessed needs of individuals admitted to the home. Daily records including night 30/06/06 care, require development to ensure that they are sufficiently detailed. (Previous timescale not met.) The manager must ensure that 30/06/06 residents receive access to health care services to meet their needs. Rugby Care Centre DS0000004292.V289048.R01.S.doc Version 5.1 Page 27 5. OP9 13(2) 6. OP9 13(2) 7. OP10 12 8. OP16 22 9. OP18 12, 13 All service users who wish to self administer their own medicines must be suitably risked assessed as able and compliance checks must be undertaken to confirm they are taken as prescribed The Medicine Administration Record (MAR) chart must record the complete drug regime prescribed by the doctor at any one time The registered person must make suitable arrangements to ensure that residents are treated in a manner that respects their privacy and dignity. A record must be kept of all complaints made which includes details of investigation and any action taken. The registered provider must review the adult abuse procedure particularly the arrangements for reporting any allegations. Staff must be made aware of changes to this. All staff must receive training on recognitions and prevention of adult abuse. The registered provider and manager must ensure that the home is free from offensive odours. (Requirement made at last inspection- Timescale 31.08.05 not met) The manager must ensure that the duty rota accurately reflects all persons working at the home and in what capacity, and the hours actually worked The manager must ensure that at all times suitably qualified and competent persons are employed in the home. Staff must receive training DS0000004292.V289048.R01.S.doc 29/05/06 29/05/06 30/05/06 31/05/06 31/05/0 31/05/06 10. OP26 16 30/06/06 11. OP27 18 30/06/06 12. OP28 18 30/08/06 13. OP30 18 & 23 31/07/06 Page 28 Rugby Care Centre Version 5.1 14. OP36 18 15. 16. OP38 OP38 13 23 appropriate to their role. This must include: Health and Safety Moving and Handling Care Planning Dementia Care The manager must ensure staff receive regular documented supervision at least 6 times per year. All substances hazardous to health (COSHH) must be securely stored. The manager must confirm that the recommendations made by the engineer in the lift report dated 13/12/05 have been undertaken. 30/10/06 26/04/06 30/06/06 Rugby Care Centre DS0000004292.V289048.R01.S.doc Version 5.1 Page 29 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP15 Good Practice Recommendations Attention should be paid to ensuring the menus, which are displayed accurately, reflect the choices available. Attention should also be paid to the quality of snacks on offer to residents The manager should ensure that a copy of the social management assessment is obtained and kept on file for all new admissions to the home. It is recommended that all medicines are transported to the service user in the locked medicine trolley and staff do not walk around the home with pots of medicines so they can be safely secured in the event of an emergency. The manager should ensure that care is given to the laundering of residents clothing. 2. OP3 3. OP9 4. OP26 Rugby Care Centre DS0000004292.V289048.R01.S.doc Version 5.1 Page 30 Commission for Social Care Inspection Leamington Spa Office Imperial Court Holly Walk Leamington Spa CV32 4YB 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 Rugby Care Centre DS0000004292.V289048.R01.S.doc Version 5.1 Page 31 - 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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