Inspection on 10/04/07 for Ruksar

This inspection was carried out on 10th April 2007.

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

Ruksar 06/02/09

Ruksar 29/04/08

Ruksar 28/09/07

Ruksar 09/01/07

Ruksar 12/09/06

Ruksar 05/05/06

Ruksar 08/03/06

Ruksar 15/12/05

Ruksar 14/09/04

Ruksar 21/04/04

Ruksar 16/12/03

Similar services:

Aston Court Nursing Home

Breme

Ravenhurst

Westmead

Ashcroft Hollow Nursing Home

Bricklehampton Hall Nursing Home

Briar Hill House

Radbrook Nursing Home

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

CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE Ruksar 26 Park Avenue West Park Wolverhampton West Midlands WV1 4AH Lead Inspector Joy Hoelzel Key Unannounced Inspection 10th April 2007 09:15 X10029.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 Ruksar DS0000017194.V335092.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 and Care Homes for Adults 18 – 65*. 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. Ruksar DS0000017194.V335092.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ruksar Address 26 Park Avenue West Park Wolverhampton West Midlands WV1 4AH 01902 420605 01902 561199 mariamathet@aol.com 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) Mr Mustak Jalal vacant Care Home 27 Category(ies) of Physical disability (27), Physical disability over registration, with number 65 years of age (27) of places Ruksar DS0000017194.V335092.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. No number division between categories Date of last inspection 9th January 2007 Brief Description of the Service: Ruksar is a care home that provides nursing, accommodation and personal care to 27 people. It is registered for adults with physical disabilities both over and under 65 years of age. The home is located close to Wolverhampton city centre, close to shops, pubs, local parks and other amenities. The home first opened in January 1993, Mr Jalal taking ownership of the home in 2002. The home is currently without a registered manager; two staff members are sharing the responsibility on a day-to-day basis. It is a two-storey building with bedrooms, communal rooms, toilets and bathrooms on both floors. There is a passenger lift accessing the first floor. There is a ramp to the front of the house but limited access to the gardens for wheelchair users. Weekly Fees range from £328.00 - £485.00. Information of the home and the provision of the service are available in the statement of purpose and service user guide. Commission for Social Care Inspection Reports for this service are available from the provider or can be obtained from www.csci.org.uk Ruksar DS0000017194.V335092.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection is the first of unannounced key inspections for 2007/08 and took place over four and half hours on Tuesday 10th April 2007. It was conducted by one regulation inspector and one regulation manager. Twenty six of the thirty eight National Minimum Standards for older people were inspected in addition to standards for Adults age 18-65. Eighteen people are currently living at the home on either a long or short term basis. Many people were seen accessing all areas of the home. A first level nurse was in charge of the premises and was supported by one registered nurse, three care staff and ancillary personnel Five case files were selected for case tracking and relevant documents were inspected. Discussions were held with people living, working and visiting the home. A tour of the premises was conducted. Prior to this inspection a meeting with the registered provider, the regulation manager and inspector was held to discuss the management situation, the lack of compliance with the requirements issued following previous inspections and the future plans for the home. An improvement plan was requested from the provider, a copy of which, dated 07/03/07, was received, the comments made in the improvement plan are included in this report. What the service does well: What has improved since the last inspection? Improvements have been made to the mealtimes ensuring that the food is served at the required temperature and people have a choice of menu to suit their preferences. The replacement of floor coverings in the private areas continues. Ruksar DS0000017194.V335092.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. Ruksar DS0000017194.V335092.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Outcomes Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6, 9, 16 and 18–21) (Standards 7, 15 and 17) (Standards 22–23) (Standards 24–30) (Standards 31–35) (Standards 8, 10 and 37–43) Ruksar DS0000017194.V335092.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. (YA NMS 1) Each service user has a written contract/ statement of terms and conditions with the home. Each Service User has an individual contract or statement of terms and conditions with the home. (YA NMS 5) No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Prospective Service Users’ individual aspirations and needs are assessed. (YA NMS 2) Service users and their representatives know that the home they enter will meet their needs. Prospective Service Users know that the home they choose will meet their needs and aspirations. (YA NMS 3) Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Prospective service users have an opportunity to “test drive” the home. (YA NMS 4) Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): OP 1, 3,6. YA 1,2. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The service has policies and procedures in place although there is evidence that practice is not consistent or well applied. Without robust admission procedures there is no guarantee that the home will be able to fully meet the individual needs of prospective service users. The statement of purpose and the service user guide do not give the current information about the home; without this prospective service users cannot make an informed choice as to the suitability of the home. EVIDENCE: Ruksar DS0000017194.V335092.R01.S.doc Version 5.2 Page 9 A copy of the statement of purpose and service user guide obtained at the inspection is available in English and Punjabi and is dated 2003. Both documents are faint, unclear and not easy to read. The statement of purpose displayed in the home’s lobby is dated March 2007; this however is noncompliant with the Regulations and National Minimum Standards as it refers to the registered manager and has no details about staffing. The complaints procedure included in the statement of purpose does not have the Commission for Social Care Inspection contact details. The Commission for Social Care Inspection requested an improvement plan from the registered provider following the key inspection in January 2007. A document dated 07/03/07 from the registered provider specified ‘the statement of purpose has been reviewed and amended by the service provider’. The case file of the most recent person admitted to the home was found to contain a social profile signed by the next of kin, information from Walsall social services, a discharge letter from a hospital and a pre admission assessment completed at the point of Admission to the home. It was not possible to establish if a member of staff had visited him in his previous placement as the assessments of needs for daily living was not signed or dated and was not fully completed. Later during the day the relative explained that she had arranged the placement of on behalf of her relative and visited the home before a decision was made. Ruksar DS0000017194.V335092.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6, 9, 16, 18 –21 (Adults 18-65) are: 7. The service user’s health, personal and social care needs are set out in an individual plan of care. Service Users know their assessed and changing needs and personal goals are reflected in their individual plan. (YA NMS 6) Also Service Users are supported to take risks as part of an independent lifestyle. (YA NMS 9) Service users’ health care needs are fully met. Service Users physical and emotional health needs are met. (YA NMS 19) 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, retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicine. (YA NMS 20) Service users feel they are treated with respect and their right to privacy is upheld. Service Users rights are respected and responsibilities recognised in their daily lives. (YA NMS 16) Also Service Users receive personal support in the way they prefer and require. (YA NMS 18) Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The ageing, illness and death of a Service User are handled with respect and as the individual would wish. (YA NMS 21) 8. 9. 10. 11. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 9, 16, 18, 19 and 20 (Adults 18-65) are the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): OP 7,8,9,10. YA 6,9,18,19,20. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Each service user has a care plan, many do not provide sufficient information on the assessed care needs and without this there is no guarantee that care needs are being fully met. Medication records are not satisfactorily completed there are gaps in recording and information. The current practice and lack of adequate recording puts people who use the service at risk. Ruksar DS0000017194.V335092.R01.S.doc Version 5.2 Page 11 EVIDENCE: Five case files were selected for inspection and included the file of the person who recently moved into the home together with people who had been at the home for varying lengths of time. The pre admission information for one person identified a specific cleansing regime prior to religious observance; the care plan did not include any details for complying with this request. The daily report records an injury for which a dressing was being made, the body chart was not completed to accurately record the site of the injury or any further treatment that may be required. Pressure relieving equipment had been assessed as necessary due to the potential risk of developing pressure areas. On observation the airflow mattress on the bed was faulty as the red warning light was on. The cells of the mattress were deflated. A nutrition preference record had been partially completed and indicated a vegetarian dietary preference. The relative informed of the person being offered a chicken curry. The same person needed assistance with transferring from one area to another; the moving and handling risk assessment and specific care plan had not been completed. The person commented to the inspector of the working practices of the care staff and ‘rough handling’ when being assisted out of bed. The person in charge spoke with the person and offered an assurance that she would instruct the staff and make alternative arrangements. Another care plan indicated that a person had mobility difficulties and required assistance from staff in this area and for all activities of daily living. There were no specific plans for maintaining personal hygiene, continence or maintaining adequate nutrition. The person had an identified risk of injury due to falling from either bed or chair. Action had been taken to reduce the risk by placing mattresses on the floor in his bedroom, provision of a ‘bucket’ type chair for use out of the bedroom and half hourly observations, however the injuries were still occurring. The daily records for another person indicated a specific treatment prescribed by a hospital doctor had not been actioned. No action had been taken by the staff at the home to obtain the prescription resulting in thirteen days delay. The person in charge contacted the supplying pharmacy during the inspection. Two case files inspected include a recent addition of pursuing religious observance to their preference, and included ‘to attend temple, listen to prayers, attend festivals’. There were no details and nothing specific about who will do this and when. During the inspection one person was exhibiting challenging behaviour, staff endeavoured to deal with this, observation of the care plan did not give any details of strategies for managing this, although development by the home of these strategies was part of the admission plan agreed via the placing authority. Ruksar DS0000017194.V335092.R01.S.doc Version 5.2 Page 12 The improvement plan document dated 07/03/07 from the registered provider specified that ‘ changes have been made in the care plan to ensure all details are recorded, moving and handling, nutritional screening and falls risk assessments are reviewed regularly’. A Blister pack system is used for the administration of medication with some additional boxes and bottles of medication. The registered nurses administer the medication. The fridge and room temperatures are being monitored daily with records kept. The nurse appeared to have a good knowledge of the drugs in use and was observed to be administering the medications as per the procedures. The Medication Administration Record chart of one person indicated that two tablets were to be given at 09.00, the chart had not been signed as given, the tablets were missing from the blister pack. The nurse offered the explanation that the night staff had administered these tablets and had ‘forgotten’ to sign for doing so. There was no evidence seen during the inspection to suggest that service users privacy and dignity were not being maintained. Staff were observed to be addressing people in an appropriate way. Ruksar DS0000017194.V335092.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 7, 11– 15 and 17 (Adults 18-65) are: 12. 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 have opportunities for personal development. (YA NMS 11) Also Service Users are able to take part in age, peer and culturally appropriate activities. (YA NMS 12). Also Service users engage in appropriate leisure activities. (YA NMS 14) Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service Users are part of the local community. (YA NMS 13) Also Service Users have appropriate personal, family and sexual relationships. (YA NMS 15) Service users are helped to exercise choice and control over their lives. Service Users make decisions about their lives with assistance as needed. (YA NMS 7) Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. Service Users are offered a healthy diet and enjoy their meals and mealtimes. (YA NMS 17) 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15 and 17 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): OP 12,13,14,15. YA 12,13,15,17 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. Limited social activities are being arranged by the care staff but are very much determined by the constraints of time and workload. There appear to be limited opportunities for people residing at the home to be independent and involved in community activities. Some improvements have been made to the menus and provision of meals. Ruksar DS0000017194.V335092.R01.S.doc Version 5.2 Page 14 EVIDENCE: After searching for the information, staff managed to establish that the afternoon’s activity was darts and dominoes, but they were unable to confirm that this was anyone’s preferred activity. One person has very active social programme that is facilitated by the cook, there appears little for anyone else. The care staff arrange the in house activities in addition to their care duties but are limited due to workload and time constraints. One carer was observed to be encouraging two older Asian women to do some movements in one of the lounges; one person described spending time as he liked in his room and getting out and about on his electric scooter. An attempt was made to engage in conversation with people in TV lounge about preferences and they said that they liked watching “soaps”. In the main lounge English TV was on plus Punjabi radio. One person spoke with the inspector and commented that they were ‘Pleased with new carpet in bedroom’. The improvement plan document dated 07/03/07 from the registered provider specified ‘a schedule of activities are already available, and service users are given choices on daily basis on their lives’. Staff were observed to be assisting people to eat the midday meal while the food was hot, not everyone was eating at the same time. There was some evidence of choice and variety with the provision of the meal, some people eating pie/chips; some eating meat curry; some with vegetable burgers; others a soft vegetable diet. People can eat in their rooms, in the lounge, in the dining room and in the TV lounge. One carer was observed to be assisting people with their meal in a sensitive and appropriate way. Generous portions were seen and people in the TV room confirmed that they get enough to eat; one person indicated that the meals were ‘OK’. Visitors at the home commented that they are able to visit at times suitable to their relative and generally felt welcome and at ease when visiting. Ruksar DS0000017194.V335092.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) 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 feel their views are listened to and acted on. (YA NMS 22) Service users’ legal rights are protected. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Service users are protected from abuse. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): OP 16,18 YA 22,23 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Written procedures are in place for protecting service users from harm, however, there appears to be a lack of awareness of implementing the procedures. EVIDENCE: The statement of purpose obtained at the time of the inspection does not contain the contact details of Commission for Social Care Inspection. The complaints procedure displayed in home’s lobby appeared to be correct and was also printed in Punjabi. The person in charge could not locate the complaints file and was unable to state if any complaints have been received since the inspection in January 2007. The Commission for Social Care Inspection have not directly received any complaints. It was not possible on this occasion to establish what systems have been introduced since the last inspection to ensure service users are protected from abuse. The improvement plan document dated 07/03/07 from the registered provider specified ‘ in house training has taken place with the assistance of Ruksar DS0000017194.V335092.R01.S.doc Version 5.2 Page 16 video and most of the staff have certificate for falls prevention, aggression management, adult protection and safe guard of adults’. The person in charge was unable to comment on this. Ruksar DS0000017194.V335092.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) Service users have access to safe and comfortable indoor and outdoor communal facilities. Shared spaces complement and supplement service users’ individual rooms. (YA NMS 28) Service users have sufficient and suitable lavatories and washing facilities. Service Users toilets and bathrooms provide sufficient privacy and meet their individual needs. (YA NMS 27) Service users have the specialist equipment they require to maximise their independence. (YA NMS 29) Service users’ own rooms suit their needs. Service Users’ own rooms suit their needs and lifestyles. (YA NMS 25) Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. (YA NMS 26) Service users live in safe, comfortable surroundings. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) The home is clean, pleasant and hygienic. The home is clean and hygienic. (YA NMS 30) The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): OP 19,26 YA 24,30 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. The physical environment does not always meet the specialist needs of the people who use the service and the assessed needs of some of the people being supported cannot be met. The overall condition of the home is poorly maintained, so that people are living in an environment that is not particularly homely, and appears shabby and unclean. The home does not have an on-going maintenance programme in place, so that essential maintenance is only done when a problem has already arisen. Ruksar DS0000017194.V335092.R01.S.doc Version 5.2 Page 18 EVIDENCE: The person in charge could not locate the programme of routine maintenance and renewal of fabric and decoration but stated that some areas have benefited from the replacement of flooring, some bedroom furniture has been replaced and table linen has been purchased. The improvement plan document dated 07/03/07 from the registered provider specified ‘ the plan for the redecoration and renewal of fabrics has been completed’. The approach to the home appears shabby and unattractive there are pots of dead flowers along the path leading to the home. On entering the home a slight odour was evident. In the lounge a waste bin was open and full of discarded waste. A small TV in the TV room is situated high up on the wall, with trailing aerial lead and power cable. Most of the communal areas appear shabby, with the décor badly in need of refurbishment and redecoration. The bathrooms, toilets and shower room appear basic and rudimentary, not homely in any way . Some are being used for storage. Inappropriate medical posters are displayed on the bathroom and toilet walls. A pane of glass is broken in the bay window. The door to the sitting room was propped open using a bedside table; it had a notice of ‘fire door keep shut’ on. The shower appeared to have been repaired but the door to the shower had not. The passenger lift was out of action for part of the morning the contractors were contacted and visited later on in the day to repair it. The airflow mattress on a bed was not in good working order the red warning light was on and the cells of the mattress were deflated. The person in charge stated that she would order a replacement that day and also stated that she would arrange for the Parker baths and other equipment to be serviced. Ruksar DS0000017194.V335092.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 35 (Adults 18-65) are: 27. 28. 29. Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. (YA NMS 33) Service users are in safe hands at all times. Service Users are supported by an effective staff team. (YA NMS 32) Service users are supported and protected by the home’s recruitment policy and practices. Service Users benefit from clarity of staff roles and responsibilities. (YA NMS 31) Also Service Users are supported and protected by the home’s recruitment policy and practices. (YA NMS 34) Staff are trained and competent to do their jobs. Service Users individual and joint needs are met by appropriately trained staff. (YA NMS 35) 30. The Commission considers standards 27, 28, 29 and 30 (Older People) and Standards 32, 34 and 35 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): OP 27,28,29,30 YA 32,34,35 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. Staffing levels and skills do not meet the needs of the people using the service, with the health and welfare of people being adversely affected. The senior staff recognise the importance of training, and attempt to deliver where possible a programme that meets the statutory requirements, however there are no reliable records of staff training that has been undertaken. EVIDENCE: The person in charge of the building was in a supernumery capacity and was supported by a registered nurse and three care staff. She stated that the cook had not arrived for duty and therefore a member of the care staff team would be requested to help out with the catering. Ruksar DS0000017194.V335092.R01.S.doc Version 5.2 Page 20 The duty rota completed for the day of the inspection indicated that the person in charge was supernumery and was supported by one Registered Nurse and four care staff. During the course of the morning staffing levels appeared to increase to include a cleaner, laundress, cook and five carers plus the person in charge and a partner in the business. One person living at the home commented that it’s ‘unusual to have lots of staff here today, here to impress the inspectors’. The training matrix has still not been completed, the person in charge stated that she is currently working on it to get it up to date. She stated that three staff are undertaking National Vocational Qualification (NVQ) level 3 in care and that nine of the staff have undertaken NVQ 2 – over 50 of the care staff team. It was not possible on this occasion to inspect the staff personnel files or to evidence the induction programme for staff. The improvement plan document dated 07/03/07 from the registered provider specified ‘ the training matrix plan has been updated and is detailed up to date, all personnel flies of the staff have been updated, all staff are going through induction programmes regularly’. Ruksar DS0000017194.V335092.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 8, 10, 23, 37 – 43 (Adults 18-65) are: 31. 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 a well run home. (YA NMS 37) Service users benefit from the ethos, leadership and management approach of the home. (YA NMS 38) The home is run in the best interests of service users. Service Users are consulted on and participate in, all aspects of life in the home. (YA NMS 8) Also Service Users are confident their views underpin all selfmonitoring, review and development by the home. (YA NMS 39) Service users are safeguarded by the accounting and financial procedures of the home. Service Users benefit from competent and accountable management of the service. (YA NMS 43) Service users’ financial interests are safeguarded. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Staff are appropriately supervised. Service Users benefit from well supported and supervised staff. (YA NMS 36) Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. Service Users know that information about them is handled appropriately, and that their confidences are kept. (YA NMS 10) Also Service Users rights and best interests are safeguarded by the home’s policies and procedures. (YA NMS 40) and (YA NMS 41) The health, safety and welfare of service users and staff are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (YA NMS 42) 32. 33. 34. 35. 36. 37. 38. The Commission considers standards 31, 33, 35 and 38 (Older People) and Standards 37, 39 and 42 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): OP 31,33,35,38 YA 37,39,42 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. The home is without a manager, is currently experiencing a period of instability and is not operating in the best interests of people living at the home. Ruksar DS0000017194.V335092.R01.S.doc Version 5.2 Page 22 Training, development and supervision of staff is inconsistent and staff lack leadership. The home is drifting and lacks purpose and direction, and residents’ needs are not being met. EVIDENCE: The home is currently without a registered manager, the person in charge stated that recruitment is ongoing to find a suitably qualified person for this position. Two senior members of the team with the input of the registered provider are carrying out the day-to-day managerial tasks. The management and administration appear somewhat chaotic with no organisation of documentation and apparently no organised structure/approach to allocating key workers/care tasks. Plans to address service users’ needs are unspecific and there’s no evidence of management monitoring whether objectives being met. Notes were available for residents’ meetings in January and March 2007; people living at the home confirmed that the meetings take place. Service users’ satisfaction surveys had been given to five respite clients during Jan/Feb 2007. The person in charge confirmed that there have been no changes to the procedures for the safe keeping of service users personal monies and valuables. One person sated that they had been provided with a lockable drawer in their bedroom and key for the safe storage of money and valuables. The person in charge appeared not to be able to locate documentation relating to health and safety e.g. service certificates for the fire alarm weren’t available after June 2005. Some records which had previously been signed off regularly had come to a stop e.g. weekly fire alarm signed off until 19.3.07; emergency lighting last tested 4.3.07; checks on the call system were maintained monthly up to November 2006; checks on exits done daily until 27.3.07. It was not possible to establish that the fire risk assessment for the premises had been updated and reviewed; a copy could not be located. The improvement plan document dated 07/03/07 from the registered provider specified ‘ the fire risk assessment completed and will be reviewed on a regular basis’. The first floor sitting room window was fully open; it did not have an opening restrictor fitted. One person was sitting in front of the window he was very low in spirit, there is a potential risk of some one falling through the window if the opening restrictors are not fitted or an assessment of the risk has not been conducted. Ruksar DS0000017194.V335092.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 1 2 X 3 2 4 X 5 X 6 N/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 ENVIRONMENT Standard No Score 19 2 20 X 21 2 22 2 23 X 24 X 25 2 26 2 STAFFING Standard No Score 27 1 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No Score 31 1 32 X 33 2 34 X 35 3 36 X 37 X 38 1 Ruksar DS0000017194.V335092.R01.S.doc Version 5.2 Page 24 Yes Are there any outstanding requirements from the last inspection? 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 OP1 Regulation 4(1) Timescale for action The statement of purpose and 31/07/07 service user guide must be reviewed and updated to contain current and accurate information of the service provision, so people can make informed choices about the home’s service and understand what is offered Previous timescale of 31/07/06, 31/10/06 and 31/03/07 Not met The service users plan of care 31/07/07 must accurately detail and record all assessed heath, personal and social care needs, so that individual needs of the residents are met consistently Previous requirement 01/01/06, 21/04/06 and 30/09/06, 28/02/07 Not met Moving and handling, 31/07/07 nutritional screening and falls risk assessments must be completed for all service users, the findings actioned and reviewed at regular intervals, so that people Version 5.2 Page 25 Requirement 2. OP7 15(1)(2) 3. OP8 17(1) Schedule 3(o) Ruksar DS0000017194.V335092.R01.S.doc 4. OP12 5 OP18 6 OP22 7 OP27 8 OP29 receive the safest and most appropriate care possible Previous timescale of 31/10/06 and28/02/07 Not fully met 16(2)(m)(n) The registered person must ensure that all service users are offered opportunities so that they can engage in leisure and recreational activities and cultural interests. Previous timescale 30/06/06, 30/09/06 and 28/02/07not met. 12(1)(a) The registered person must ensure that systems are in place so that vulnerable people are protected from potential or actual abuse. Previous timescale 30/09/06 and 28/02/07 not met. 16(2)(c ) To reduce the risk of a person developing pressure ulcers following a risk assessment all equipment deemed to be essential for this purpose must be in good working order and maintained at regular intervals. 18(1)(a) The registered person must ensure that the ratios of staff be reviewed with the levels of staff appropriate to the assessed needs of the people living at the home, taking into account the size, layout and service provision. Previous timescale 30/06/06, 30/09/06 and 28/02/07 not met. 19(1)(2)(3)(4) The registered person must ensure that the personnel files for staff employed post April 2002 contain the documentation required in DS0000017194.V335092.R01.S.doc 31/07/07 31/07/07 31/07/07 31/07/07 31/07/07 Ruksar Version 5.2 Page 26 9 OP30 18(1)(a) 10 OP38 13(4)( c) 11 OP38 23(4) Schedule 2 of the regulations Previous timescale 30/06/06 and 30/09/06 not fully met. The registered person must 31/07/07 ensure that all staff receive an induction programme that meets the Skills for Care specifications, so that they can work safely Previous timescale 30/06/06 and 30/09/06 not met. Not fully inspected at this inspection Regular monitoring must be 31/07/07 carried out for the fire alarm system, emergency lighting, hot water temperatures, legionella, use of chemicals, gas and electricity supplies and all equipment in use at the home. Records must be maintained in order to demonstrate that systems are safe and reduce the risk of harm to staff and residents The registered person must 31/07/07 ensure that a fire risk assessment for the premises is completed and reviewed on a regular basis, in order to protect people who live and work at the home Previous timescale 30/10/06 and 28/02/07 not met. 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 Ruksar Refer to Standard OP2 Good Practice Recommendations It is strongly recommended that procedures are adopted DS0000017194.V335092.R01.S.doc Version 5.2 Page 27 2 OP16 3 OP19 4 5 6 7 8 9 OP21 OP26 OP28 OP31 OP33 OP38 for the Medication Administration Record charts to be completed at the time of administering the medications. It is strongly recommended that the contact details for contacting the Commission for Social Care Inspection are detailed in the statement of purpose, service user guide and complaints procedure It is strongly recommended that the programme for the redecoration and renewal of fabric continue. Previous timescale for requesting this - 12/04/06 and 28/02/07 not met. The environment (communal areas, toilets and bathrooms) would benefit greatly from redecoration and refurbishment To improve the quality of life for the people using the service all areas of the home should be free from offensive odours. The training matrix should include all details of the training opportunities of the staff and be updated regularly. The service would greatly benefit from a suitably qualified, competent person to manage the home on a day to day basis. The results of service user surveys should be published and made available to service users, interested parties and the commission. All windows above ground floor level should be fitted with opening restrictors or be adequately risk assessed to reduce the risk of accidents. Ruksar DS0000017194.V335092.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Shrewsbury Local Office 1st Floor, Chapter House South Abbey Lawn Abbey Foregate SHREWSBURY SY2 5DE 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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