Inspection on 08/01/08 for Ruishton Court Nursing & Residential Home

This inspection was carried out on 8th January 2008.

CSCI found this care home to be providing an Good service.

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

Ruishton Court Nursing &... 15/09/09

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

CARE HOMES FOR OLDER PEOPLE Ruishton Court Nursing & Residential Home Henlade Taunton Somerset TA3 5LT Lead Inspector Gail Richardson Unannounced Inspection 09:20 8 January 2008 th 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 Ruishton Court Nursing & Residential Home DS0000070811.V359873.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. Ruishton Court Nursing & Residential Home DS0000070811.V359873.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ruishton Court Nursing & Residential Home Address Henlade Taunton Somerset TA3 5LT 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) 01823 443443 01823 443443 ruishtoncourt@aol.com Ruishton Court LTD Carol Mary Palmer Care Home 33 Category(ies) of Old age, not falling within any other category registration, with number (33) of places 359873 Ruishton Court Nursing & Residential Home DS0000070811.V359873.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Elderly persons of either sex, not less than 60 years, who require general nursing care Up to three persons of either sex, over the age of 50-59 years, who require general nursing care Up to 3 places for personal care Date of last inspection 12th September 2006 Brief Description of the Service: Ruishton Court Nursing Home provides general nursing care and personal care for up to 33 older people. The home is on the outskirts of Taunton set in large well-maintained grounds, which are accessible by wheelchair via a ramp at the front door. The home is formed from a converted hundred-year-old house; accommodation is on three floors with connecting shaft lift. The home has twenty-two rooms used as single occupancy and four double rooms. All rooms have en suite facilities. There are communal dining rooms and two main lounges on the ground floor. The home has been suitably adapted for the current resident client group with handrails in corridors and grab rails in toilet facilities. The home has a nurse call bell system throughout. There are the health and safety measures of low surface temperature radiators and hot pipes are covered. There is restricted opening of all above ground floor windows and hot water temperature controls at all bath and basin outlets. There is a Registered Nurse on duty at all times. An Activities co-ordinator is employed part time and provides a varied programme of activities for groups and individuals according to need. The home is well maintained, comfortably furnished and has a homely atmosphere. The fee range is between £512.00 and £800.00 and the fees ranges varies for shared rooms Items not included in the fees include hairdressing, chiropody, newspapers and admission to some excursions . Ruishton Court Nursing & Residential Home DS0000070811.V359873.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience Good quality outcomes. This was an unannounced inspection, which took place over 1 day (7 hours) on the 8th January 2008 by inspector Gail Richardson. A tour of the home took place and a selection of bedrooms and all communal areas were seen. There were 26 people using the service currently residing at the home, 2 of whom were receiving personal care only and the remainder are receiving nursing care. The inspector spoke with 5 people using the service, 1 visitor and 6 members of staff, the Registered Manager was available throughout the inspection. The inspector spent time talking to people using the service, visitors and staff and observed that on the day of inspection, people appeared comfortable in all areas of the home and the atmosphere was calm. All people using the service spoken to, and who were able, spoke of the staffs kindness and support. The home also provided CSCI with a completed AQAA (Annual Quality Assurance Audit) which was completed by the Registered Manager and gives details of all aspects of the home. Records relating to care including 4 care plans, 4 staff files, finances and health and safety records were examined. As part of this inspection the inspectors surveyed the opinions of a random selection of residents and their representatives, GP’s, District Nurses and Care Workers, a moderate response was received and their comments will be included in this report. The focus of this inspection visit was to inspect relevant key standards under the CSCI ‘Inspecting for Better Lives 2’ framework. This focuses on outcomes for service users and measures the quality of the service under four general headings. These are; - excellent, good, adequate and poor. The following is a summary of the inspection findings and should be read in conjunction with the whole of the report. What the service does well: Ruishton Court Nursing & Residential Home DS0000070811.V359873.R01.S.doc Version 5.2 Page 6 All people using the service who spoke with the inspector were complementary about the kindness and caring attitude of the staff. Comments included ; ‘We are happy to find a cheerful staff who are helpful to me’ ‘The staff are always kind and attentive’ ‘I am satisfied with the standard of the home and the excellent way it is run. ‘ ‘The staff are friendly and helpful and communicate well.’ The home appears to be clean and tidy with an ongoing maintenance program. The home has recently reorganised the office arrangements and created a larger treatment room and now has internet access available within the home. The home has a designated staff trainer employed 4 days per week. Staff training is ongoing and progressive in that it encourages staff to develop their role. Over 50 of staff have completed an NVQ qualification. Several comments were received about the quality and variety of meals at the home. People using the service confirmed that choice is always available and the meals are always served hot. The home uses a nutritional screening tool to identify any risk areas and subsequent action and monitoring is recorded in the care plan. People using the service have the facility to self medicate if they wish they are supported to promote ongoing independence. Risk assessments are required to support the person and suitable ordering and storage facilities are provided. What has improved since the last inspection? The registered manager has implemented a new care planning system which it is planned to develop person centred care. The care planning system is clear and provides risk assessments and care plans for each person using the service. Further development is planned to continue to improve the system. The recording of prescribed creams has been addressed with a system incorporated within the care plan for staff to sign when creams are administrated. The recording of dietary supplements is now recorded on the Medication Administration Records . The management of the home now includes the room number on each service users contract with the home. Risk assessments were recommended for the tea making facilities provided on each floor. The home has removed the kettles and replaced them with heated thermos flasks to ensure that people using the service are not placed at risk of burns and scalds. Ruishton Court Nursing & Residential Home DS0000070811.V359873.R01.S.doc Version 5.2 Page 7 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 Ruishton Court Nursing & Residential Home DS0000070811.V359873.R01.S.doc Version 5.2 Page 8 contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Ruishton Court Nursing & Residential Home DS0000070811.V359873.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Ruishton Court Nursing & Residential Home DS0000070811.V359873.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 2 3 4 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home continues to provide prospective residents and relatives with sufficient information in the format of brochures, the Service User Guide and Statement of Purpose for them to make an informed decision about the home. All prospective residents receive a pre admission assessment to ensure the home can meet the assessed needs identified. EVIDENCE: 3 Residents surveys and 6 relatives surveys felt they had received enough information prior to admission, about the home to make an informed decision. 5 relatives surveys received stated that they had received a contract. Comments included ‘My relatives both showed me around the home prior to me coming here’. Ruishton Court Nursing & Residential Home DS0000070811.V359873.R01.S.doc Version 5.2 Page 11 The homes AQAA (Annual Quality Assurance Audit) states that ; As much time as possible is spent with people viewing the home to ensure they are comfortable with the surroundings. Full assessments of residents needs are done to ensure these needs can be met. Contracts are issues after one months trial period. People using the service confirmed this to be the case. One qualified staff stated that they are involved in pre admission assessments. It was noted that the pre admission records for one person were not available, it is recommended that the registered manager review the filing arrangements to ensure that staff could access the pre admission documentation for reference purposes. There was evidence on the day of inspection that people using the service were offered alternative rooms depending on availability. The home has produced a Statement of Purpose incorporating the Service User Guide which is made available to prospective people using the service and their representatives. This has recently been updated to contain current detail of the home. The contract provided was seen to contain sufficient information and included the terms of residency. Ruishton Court Nursing & Residential Home DS0000070811.V359873.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7 8 9 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Each person using the service has a care plan, most of the assessed areas of need were reflected in this plan of care and the detail recorded ensures that staff can provide for those needs. Further development of the care plan is recommended to ensure all areas of assessed need are care planned. Medication systems were assessed to be good. Staff were observed to treat people with dignity and respect at all times and people using the service felt well cared for. EVIDENCE: The registered manager has recently implemented a new care planning process to reflect a more person centred approach to care. The homes AQAA states that ; A good start has been made to resident centred care and a review of the key worker system is in place. Ruishton Court Nursing & Residential Home DS0000070811.V359873.R01.S.doc Version 5.2 Page 13 The inspector examined 4 care plans and found there to be sufficient detail to ensure that staff were informed of the abilities of people using the service and how their independence could be maintained whilst supporting them in other areas of care. The care plans undertaken so far were detailed and reflected peoples choices and preferences. There was sufficient evidence contained within the daily record to confirm that care was being undertaken, however, not all the areas of detail in the daily record were being transferred or highlighted within the care plan. The registered manager explained that at this was currently being undertaken and was seen on inspection to be the case. The care plans also contained risk assessments including manual handling and nutritional assessments and evidence of ongoing contact with visiting health professionals. The home receives regular Community Psychiatric nurse input. Regular reviews of the care plan were seen to have taken place. There was some evidence of input from relatives but further input in care planning by people using the service and their relatives /representatives is recommended. When asked do you receive the care and support you need, 4 surveys said always and 3 said usually, all 7 responded that staff listen and act on what the residents say and 4 felt they always received the medical support they needed and 3 said usually. When asked if the care home meet the needs,5-always and 2-usually. 15 staff surveys received, confirmed that 11 staff were involved in care planning for people using the service and it was observed that the care plan was being used as a working document within the home as a point of reference. People using the service who spoke to the inspector were very complementary about the care they receive and about the kindness and caring attitude of the staff. Staff were observed to treat people with dignity and respect and interacted in a personal and professional manner. It was observed that staff appeared to have a good knowledge of peoples needs. People using the service who spoke with the inspector, were able to confirm that they were able to make choices about their routine, meals and how they spent their day. Comments received from surveys included; ‘I have made suggestions to the staff about my relatives special likes and dislikes-my ideas have always been appreciated and carried out’. ‘Staff are approachable and friendly’ ‘Care plan is good’ ‘Atmosphere in the home is good’ Ruishton Court Nursing & Residential Home DS0000070811.V359873.R01.S.doc Version 5.2 Page 14 ‘The home does everything well’ ‘Staff are very good, I have choice’ ‘I am very happy with the care and residents here and many a laugh is had by all’ ‘The staff do their bests to keep residents happy and content as well as looking after their physical needs’ The medication systems were assessed to be good. The home has written protocols in place on the Medication Administration Records for the administration of most medications. There were no gaps evident in the Medication Administration Records and the registered manager explained that she plans to implement an auditing system in the near future. There was evidence of variable doses being recorded and hand transcribed entries being signed by 2 staff. The registered manager has implemented a system to record the administration of all prescribed creams on a record within the care plan and dietary supplements were notes to be recorded on the Medication Administration Records. People using the service have the option to self medicate should they want to. Risk assessments are recommended to be in place to ensure safe practice is maintained. Lockable storage is available as required. A homely remedy policy is in place with signed consent on agreed protocols by the relevant GP’s. All medications were stored safely and securely with systems in place for ordering and disposal. Ruishton Court Nursing & Residential Home DS0000070811.V359873.R01.S.doc Version 5.2 Page 15 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. This judgement has been made using available evidence including a visit to this service. There is a range of opportunities for social stimulation which is recommended to be recorded regularly to develop a more person centred approach to activity provision. People are supported to join in with some organised activities or pursue their own interests. The meals in the home are of a good quality and a wide range of choice is available. EVIDENCE: Resident’s surveys asked are there activities arranged by the home that you can take part in, 2 -always, 2 usually, 2-sometimes. Comments received included; ‘I feel that Ruishton court provides good care in a friendly environment and also has plenty of activities going on which the residents need and definitely enjoy.’ Ruishton Court Nursing & Residential Home DS0000070811.V359873.R01.S.doc Version 5.2 Page 16 ‘I choose not to join in with the arranged activities. I am content in my own room.’ ‘Activities here are very good and very entertaining, loads of fun’. The home employs one part time activity staff and is trying to recruit another part time staff to cover the week. There is weekly plan of activities which is available on the notice board in the main foyer. The inspector observed that the activity coordinator spent the morning serving coffee and using this time to sit and talk to people either on a one to one or group basis. She visited people in their rooms and gave help as required to drink the coffee. Later in the morning she spent time in the lounge. The afternoon involved a game of bingo. The hairdresser was also visiting and this was observed to be a social event. People using the service who spoke with the inspector felt that there was sufficient activity and they had a choice if they wanted to join in. The trips out were confirmed as enjoyable. The recording of activities requires further development to promote a more person centred approach to activity provision. Not all activities and interaction are currently recorded within the care plan and so the peoples response and participation could not be gauged. One visitor to the home confirmed that they were always made welcome to the home and found staff to be helpful and they felt that there was ongoing communication regarding changing care needs. There were visitors to the home throughout the day and it was noted that staff offered visitors the opportunity to see their relative in private. People using the service’s rooms were decorated in a manner, which reflected their tastes and lifestyles. Evidence was seen in some cases of people’s own furniture and personal items in their bedrooms. Lunch observed was appetising and plentiful and a choices related to personal preferences were provided. Kitchen staff spoken to, had a good understanding of peoples dietary needs. The menu offers a choice and people using the service were complementary and satisfied with the meals provided. Special diets were available and pureed diets were served separately. Meals were served both in the dining room and in peoples bedrooms if preferred. The choice was offered for the following day but it was observed that people using the service were able to change their mind if they wanted to. The dining tables were nicely laid and wine was available. The menu was on each table in large print. Ruishton Court Nursing & Residential Home DS0000070811.V359873.R01.S.doc Version 5.2 Page 17 On the day of inspection lunch consisted of: Cottage Pie or sausages with cheese/potato pie. Desert was lemon love cake and cream or tapioca. Supper was potato and pea soup, egg and cress or tuna and mayonnaise sandwiches or ham and cheese slice with a choice of deserts. Resident’s surveys asked if residents like the meals at the home, 4 always, 3usually. Comments received included; ‘My relative says she is happy here, likes the surroundings enjoys the food.’ ‘The variety and quality of the meals are generally of a good standard.’ ‘Food-great variety and very good food’ ‘Good varied menu with options for personal choice or snacks’ Ruishton Court Nursing & Residential Home DS0000070811.V359873.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 17 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff and people using the service are confident that the homes management team would appropriately deal with any complaints or concerns. Policies, procedures and training are available to staff to ensure they have the knowledge to prevent people from the risk of abuse. Recruitment procedures protect people using the service from the risk of abuse. EVIDENCE: Relatives surveys and 7 people using the service surveys, confirmed that they knew how to make a complaint and surveys confirmed that people knew who to speak to if they were unhappy. One comment received was ‘I have no complaints but if I did I would know what to do’. On the day of inspection all people using the service and staff who were asked were comfortable to approach the registered manager or staff at the home and were confident that any issues would be dealt with appropriately and promptly. The home has a complaints policy which was not on display at the home but available within the Statement of Purpose/Service User Guide. The registered manager ensured that a copy was placed publicly during the inspection. Ruishton Court Nursing & Residential Home DS0000070811.V359873.R01.S.doc Version 5.2 Page 19 The home has received 2 complaints since the last inspection. One complaint was completed following a thorough investigation by the home and the second concern is ongoing. The home has access to an advocacy service for people who may require an independent advocate. All people using the service are registered to vote. The homes AQAA states that All staff during induction are asked to watch a video informing them of the different types of abuse and signs to watch out for. Whistle blowing is encouraged. All 15 staff surveys confirmed that they were aware of policies about protecting vulnerable adults and how you report any concerns about poor care practice or allegations of abuse. The home has abuse awareness policies and is recommended to provide staff with a policy to outline the action to be taken regarding people using the service who may have challenging behaviour. The whistle blowing policy is recommended to contain the contact details for the agencies identified. The recruitment procedures followed by the home are robust and are in place to protect people using the service from the risk of abuse. One employment history had an unexplained gap which the manager was aware of but had not documented. All 15 staff surveys received confirmed that they had received a Criminal Record Bureau Check and examination of recruitment files confirms that these check were undertaken before staff commenced employment. Ruishton Court Nursing & Residential Home DS0000070811.V359873.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 20 21 22 23 24 25 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is a large building with some parts of the building suffering from wear and tear that would be typical of a building of similar age and usage. An on going refurbishment program is in place and improvements to areas of the home are evident. EVIDENCE: The inspector made a tour of the home and saw a sample of bedrooms, all communal areas , kitchen and laundry. The home is a large Victorian building which has been adapted for purpose whilst maintaining some original features. The is lift and stair access to all areas with ramped access to outside areas including attractive gardens. Hand rails appear available throughout the home People’s bedrooms are personally decorated and well maintained. Ruishton Court Nursing & Residential Home DS0000070811.V359873.R01.S.doc Version 5.2 Page 21 There is ample communal space available, with a quiet lounge available on the ground floor for visitors to have private space. Where double rooms are used , suitable screening for privacy is provided. There is access to specialist equipment and adaptations to promote independence. Specialist pressure relieving cushions and mattresses were seen were there was an assessed need. All wheelchairs were seen to be clean and maintenance records available. Toilet and bathing facilities are provided in sufficient numbers and were clean and odour free. 2 bathrooms were noted to be in need of repair to ensure that there is no risk of cross infection. Hand wash arrangements to reduce the risk of cross infection were in place in bathrooms and toilets. The general standard of cleanliness was good and no unpleasant odours were evident. The cleaning and laundry staff confirmed that they received sufficient training and that they considered the hours sufficient to maintain the hygiene of the home. 2 cleaning staff were observed to work to a system which involves all areas of the home. All 7 residents surveys confirmed that the home is always clean and fresh. Ruishton Court Nursing & Residential Home DS0000070811.V359873.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27 28 29 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing levels at the home appear adequate to meet the assessed needs of people using the service and staff training is promoted, comprehensive and well recorded. The recruitment process is robust and protects people using the service from the risk of harm. EVIDENCE: The Registered Manager, staff members and people using the service confirmed that they felt there were enough staff on duty to meet peoples needs. The homes AQAA states that Staff rotas are prepared well in advance and skill mix is considered, especially with several new members of staff in post. This ensures the best possible care for the residents. Agency staff are used when necessary. Resident’s surveys asked if staff were available when you need them said, 3 always, 4 -usually. When asked, Do staff have skills and experience to care properly, 5- always, 2 -usually. Ruishton Court Nursing & Residential Home DS0000070811.V359873.R01.S.doc Version 5.2 Page 23 Comments received for surveys included; ‘They probably need more staff.’ ‘Staff are approachable and friendly.’ ‘The staff are always kind and helpful to me’ ‘At busy times it sometimes takes longer for staff’ ‘The staff do their bests to keep residents happy and content as well as looking after their physical needs’ ‘The staff are very kind and understanding with residents who are a little confused and worried’. ‘Occasionally staff shortages can affect the level of care provided’ ‘I am very impressed by the staff they’re excellent’ On the morning of inspection there was the registered manager, 1 qualified staff and 6 care assistants. Also on duty was 1 activity coordinator, 2 kitchen staff, 2 cleaning staff, 1 laundry staff and 1 administrative staff. The afternoon shift consisted of 1 qualified nurse and 5 care assistants and the night shift consists of one qualified staff and 2 care staff. The home employs a staff trainer 4 days per week. This staff member works with all new staff on an induction programme. At this time staff receive training in manual handling ,fire safety, infection control and abuse awareness. Further areas of training are also covered, the trainer then reviews the induction with staff one year later with refresher training. One recently employed staff member confirmed that induction took place and was thorough. Over 50 of staff have completed NVQ2 and a further 5 staff have just commenced training. Staff surveys stated when asked, Do you ever have to deal with situations you feel unprepared for or do not have the right training for, 4-yes and 11 – no. 15 staff returned comment cards to CSCI, all 15 staff confirmed that they felt they had received adequate induction and supervision when they commenced their job. All 15 staff confirmed that they were clear of what the service users needs were and also 15. staff were aware of the duties they must not undertake. When asked by survey, Have you received Manual Handling Training, all 15 responses said yes however one comment received was ‘Manual handling training is not adequate’. Domestic staff had access to data sheets and had received training in the use of the chemicals provided. Staff receive supervision regularly from the staff trainer and this is then used to develop further training needs. A discussion took place on widening the Ruishton Court Nursing & Residential Home DS0000070811.V359873.R01.S.doc Version 5.2 Page 24 scope of topics to clarify all areas for discussion in supervision in the National Minimum Standards. Four staff files were examined. These staff members had been employed since the previous inspection. All contained evidence of a thorough recruitment process. Application forms include details of previous employment and only one gap in employment was evident. The manager was aware of the reason for this and would ensure the reason for the gap was documented. The staff employed all had evidence of POVA First and CRB checks. The home records supervised practice on the off duty rota, when the staff member commences work. Ruishton Court Nursing & Residential Home DS0000070811.V359873.R01.S.doc Version 5.2 Page 25 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 32 25 36 37 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is effectively managed and benefits from the positive and proactive management style of the Registered Manager. The management of people using the service monies in the home is subject to auditing by the home to ensure that monies are handled safely by the home. Records inspected were maintained well and were stored in a confidential manner. Staff are appropriately supervised and supported Systems are in place to ensure the health and safety of service users whilst encouraging and promoting independence. Issues raised are identified within the report. Ruishton Court Nursing & Residential Home DS0000070811.V359873.R01.S.doc Version 5.2 Page 26 EVIDENCE: All staff, one visitor and people using the service spoken with at the inspection, were positive regarding the management style of the manager and staff said they felt supported and people using the service felt the manager was accessible. The manager is currently undertaking the Registered Managers Award. Quality assurance questionnaires were last sent out in 2007 and were available for the public on the foyer notice board. People using the service personal finances were held in an appropriate and secure manner. Each person had their own record of transactions, containing and balance and receipts and an individual pocket of money. This was randomly audited by the inspector and found to be correct. Routine auditing of all personal finances by the administrative staff takes place every 6 months. 15 staff stated on the comment cards supplied that they were receiving regular supervision. The supervision records noted that not all areas outlined in the National Minimum Standards were covered during the supervision sessions and this is recommended to be reviewed. The policies and procedures for the safe storage of records and documents meet the requirements under the Data Protection Act. Maintenance records were seen, these included ; Fire safety- Fire extinguisher checks were undertaken annually 25/02/07,the fire safety system is checked annually 28/06/06 and is due for review. The fire alarm system is checked weekly by the maintenance staff and was last checked 07/01/08 when the staff undertook the weekly fire drill. The fire risk assessment is due review and update as it was last reviewed on 27/11/06. Emergency lighting was serviced on 28/06/06 and is checked monthly buy the maintenance staff 27/11/07 The lift is serviced annually 18/10/07 The hoists are services bi annually 18/09/07 Portable appliances are tested annually or as required 16/03/07 Hard wiring is tested every 5 years 01/07/07 Gas safety is checked annually 30/07/07 Hot water temperatures are checked at all outlets monthly and were last checked 10/11/07 Call bells are checked annually 27/07/07 Ruishton Court Nursing & Residential Home DS0000070811.V359873.R01.S.doc Version 5.2 Page 27 Environmental health visited 08/01/08 15 staff surveys received stated that they were provided with protective clothing and necessary equipment to do their work safely and cleaning staff confirmed that they had access to COSHH data sheets and had received training in the safe use of chemicals. 3 cleaning solutions were noted to be accessible in the ground floor bathroom and were confirmed as removed by the provider at inspection. The storage of substances hazardous to health must be in line with the COSHH guidelines. Ruishton Court Nursing & Residential Home DS0000070811.V359873.R01.S.doc Version 5.2 Page 28 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 3 2 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 2 1 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 X X 3 2 3 2 Ruishton Court Nursing & Residential Home DS0000070811.V359873.R01.S.doc Version 5.2 Page 29 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 OP18 Regulation 21(1) Requirement The registered manager is required to provide staff with a policy related to the management of people using the service who may present with challenging behaviour. The registered provider is required to ensure that bathrooms identified at inspection are repaired to prevent any risk of cross infection. Timescale for action 01/02/08 2. OP19 13(4) 01/04/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP3 OP7 Good Practice Recommendations The registered manager is recommended to ensure that pre admission assessments are stored in a place which is accessible for reference. The care plans used within the home are recommended to be further developed to ensure that all areas identified within the daily record and risk assessments have an DS0000070811.V359873.R01.S.doc Version 5.2 Page 30 Ruishton Court Nursing & Residential Home 3. 4. 5. OP7 OP9 OP12 6. 7. OP18 OP36 8. 9. OP38 OP38 appropriate plan of care available for staff to use. The further involvement of people using the service and their relative/representative in the care planning process is recommended. The registered manager is recommended to provide a regularly reviewed risk assessment for all people using the service who self medicate. The registered manager is recommended to ensure that recording of all activities and individual social interaction is recorded and used to develop a person centred approach to activity provision. The registered manager is recommended to include the contact details of the agencies identified within the homes whistle blowing policy. The registered manager is recommended to ensure that supervision takes place 6 times per year and includes all the topics noted within standard 36 of the National minimum Standards. The registered manager is recommended to ensure that all substances which are hazardous to health are stored securely to avoid the risk of accidental ingestion. The registered manager is recommended to review and make any required updates to the fire risk assessment. Ruishton Court Nursing & Residential Home DS0000070811.V359873.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Taunton Local Office Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL 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. 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