Inspection on 12/09/06 for Ruksar

This inspection was carried out on 12th September 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 10/04/07

Ruksar 09/01/07

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 12th September 2006 09:30 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.V307138.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.V307138.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.V307138.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. No number division between categories Date of last inspection 5th May 2006 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. Weekly Fees range from £328.00 - £485.00. 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. 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. Information on the service provision is available in the form of a statement of purpose and service user guide both documents are available in English and Punjabi. Ruksar DS0000017194.V307138.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 second of unannounced key inspections for 2006/07 and took place over six hours on Tuesday 12th September 2006. It was conducted by two regulation inspectors. One inspector focused on the care provided to people from the black and minority ethnic communities and had discussions with the older Asian ladies and their visitors. The other inspector looked at staffing issues and the environment. Twenty five of the thirty eight National Minimum Standards for older people were inspected in addition to standards for Adults age 18-65. Twenty one service users were on the premises with one service user in hospital receiving treatment. A first level nurse was in charge of the premises and was supported by three care staff and ancillary personnel. The owner arrived at the home during the morning. Three case files were selected for case tracking, staff personnel files and other relevant documents were inspected. Discussions were held by both inspectors with numerous service users, visitors and staff. A tour of the premises was conducted. What the service does well: What has improved since the last inspection? Forty seven requirements were made following the statutory inspection in May 2006 of which thirty two were met. Alternative flooring has been fitted in some bedrooms where there was an assessed need for change. Bedroom furniture, curtains and table linen has been purchased. Ruksar DS0000017194.V307138.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. Ruksar DS0000017194.V307138.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.V307138.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 to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): OP 3,6. YA 2 Quality in this area is poor. This judgement has been made using available evidence including a visit to this service. There is no clear or consistent assessment process in place to adequately inform the care planning process and provide staff with the information they need to satisfactorily meet service users needs. EVIDENCE: Three service users files were sampled during this inspection. Two were of service users recently admitted to the home and one for a service user who had been at the home for some time. Ruksar DS0000017194.V307138.R01.S.doc Version 5.2 Page 9 The pre-admission assessment of one of the service users recently admitted had been carried out on the day of admission to the home and staff had not accessed a full assessment carried out by the social worker or any other person competent to carry out such an assessment before agreeing to admit the service user to the home. The pre-admission assessment briefly covered several areas of need including communication, mental state, mobility, eating and drinking. For example, the assessment indicated that mobility was very limited requiring help and support from other people. There was no information about the support needed and how it was to be provided. With respect to personal care it merely stated the service user was dependant. There was little information about the cultural and social needs of the individual apart from the religion and that they watched the television and listened to the radio. The home does not provide an intermediate care service. Ruksar DS0000017194.V307138.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 to be inspected at least once during a 12 month period JUDGEMENT – we looked at outcomes for the following standard(s): OP 7,8,9,10. YA 6,9,16,18,19,20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Care plans were improving but required further development regarding the level of detail of needs and how these are to be met by the care staff. Risk assessments must be cross-referenced to the care plans to show how the risks were being managed. The health care needs of the service users were being met. EVIDENCE: Ruksar DS0000017194.V307138.R01.S.doc Version 5.2 Page 11 Three case files were selected for inspection and indicated that the home had made a start on the assessment of daily living needs however, there was no information regarding oral or foot care, hearing or vision or dietary likes and dislikes apart from that the service user could eat without help but needed encouragement. This was different to the pre-admission assessment that stated a soft diet was required. A soft diet was observed at lunchtime. The first care plan had not yet been fully completed. A care plan for personal care was in place however this was a generic form that did not encourage individualisation for each person. This plan indicated that dentures needed to be soaked overnight or teeth cleaned twice a day. It was observed at lunchtime that the person was not wearing dentures and did not appear to have any teeth. The moving and handling, falls risk, and nutritional screening assessments had not been completed. It was noted from the daily records that this individual had had two falls since being admitted to the home and that the service user was brought to the lounge in wheel chair and two staff were needed to transfer the person to an easy chair. The second file was of a service user also recently admitted to the home. A social work assessment had been received for this person that provided good detail of their needs. Some of the care plans were generic and were not individualised to the person for example, personal care. There were other care plans specific to the needs of this service user. The person was more independent and able to go out and decide how to spend their day however, there was no identified plan for meeting the social needs of the service user. The person felt that some independence had been lost due to limited mobility because of the structure of the home and that there were limited opportunities for socialisation. The third file was for a person who had been at the home for some time. There were more detailed care plans for the health care needs of this person who was totally dependent on the staff for care however, there were still gaps in the records for instance what language was spoken, religious needs and social needs. There was evidence on the files sampled that service users were being referred to doctors, nurses, opticians and chiropodists as required and their health care needs were being met. The home operates a twenty eight day regimen for the administration of medication using a monitored dose system with the additional use of bottles and boxes of medication. The morning medication round was observed and was being conducted by the person in charge, the medication trolley was being taken to individual service users from where the medication was being Ruksar DS0000017194.V307138.R01.S.doc Version 5.2 Page 12 dispensed. The nurse was completing the Medication Administration Record (MAR) at the time of offering the medication to the person. The policy and procedure for the handling of medications within the home had been reviewed on 29/05/06. Two staff are checking all medications received into the home and the quantity recorded on the MAR chart. A new fridge for the cold storage of medications has been purchased; the maximum/minimum temperature is recorded daily. The nurse in charge stated that the regular audit of the medications to ensure the integrity of the MAR charts and that the consistency of the supply of medication is maintained is yet to be arranged. The date of opening has been placed on some products that have short shelf life; during the tour of the building the date of opening had been omitted from a tub of Sudocrem. Protocols had not been developed for the use of ‘when required’ medication. Without such protocols staff do not have the necessary information of the circumstances that trigger the administration of these medications. The person in charge confirmed that regular contact is made with the diabetic specialist nurse at the local hospital for monitoring and maintaining optimum blood sugar levels for the people with diabetes. During the tour of the building it was observed that a service user required oxygen to be available for use at all times and a cylinder of oxygen was in her bedroom. A warning sign stating that oxygen is in use in the bedroom had not been placed on the bedroom door. The person in charge attended to this immediately and a sign was placed on the bedroom door. There was no evidence seen during the inspection to suggest that service users privacy and dignity were not being maintained. Ruksar DS0000017194.V307138.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): OP 12,13,14,15. YA 12,13,15,7 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. Quality of the service users lifestyles was limited by the staffing levels in the home, the activities available within and outside the home and the food was not to all service users satisfaction. There was good contact with families however; there was limited contact with the outside community. EVIDENCE: There was evidence of some activities taking place for example, visits to the corner shop, trip to Stapely Water Gardens and some barbeques in the home. Ruksar DS0000017194.V307138.R01.S.doc Version 5.2 Page 14 On the day of the inspection there was observed to be some music on in the main lounge, however, the television was also on, during the afternoon there was some colouring in being undertaken by two service users and three service users were being encouraged to play indoor skittles. One person commented that ‘this was being done for the benefit of the inspectors to show how caring they were’. Other service users also commented on the lack of ‘things to do in the home’. There were some people who were able to go out independently and some who were taken out by their relatives. The quality of life for the more dependent service users appeared to be limited. The home needs to consult service users and relatives to develop a programme of activities both within the home and external to ensure that all service users needs were met. There was no evidence that any of the service users were facilitated to attend local places of worship or that any links had been developed with the places of worship for visits to the home. The inspector was informed that Eid and Diwali celebrations were organised in the home. Service users and a visitor spoken to during the inspection confirmed that visitors were welcome in the home at any time. Visitors were seen to come and go during the day. There appeared to be limited choices available to some of the service users. Two people stated that they could not have more than one bath a week, there was little choice of what to do during the day for some service users and there was limited scope for socialisation. One person stated that they spent a lot of time in their bedroom as there was no where to sit except in the dining room and there was no one to talk to in the lounge due to different languages being used. The inspectors were able to take lunch with some of the service users. The dining area was small and could not accommodate all the service users. There were seven people in the dining room. Other service users ate in the lounges or their bedrooms. The inspectors found lunchtime to be a very functional activity. The setting of tables had not been fully completed with some service users not having been given a knife or serviettes, the condiments had to be requested, as they were not available on either tables. Ruksar DS0000017194.V307138.R01.S.doc Version 5.2 Page 15 One person stated that the meal was ‘bland’. The person was having a soft diet of creamed potatoes and peas. The person asked for sugar to be put on the meal as it was bland and thought it was rice pudding. One carer put salt on the dinner and another carer put sugar on it. At one point the inspector asked whether pepper could be put on for the person, however, there was none available on the table and it took some time for the pepper to be brought out. One of the inspectors had a vegetable lattice that was difficult to cut. One of the care staff also found it difficult to cut as a large piece was put into the persons mouth and half of it was hanging down the chin. The other inspector had the alternative meal and found that this was acceptable. Most of the other service users stated that they had enjoyed their meal although a couple of the service users stated that the food was not to their liking. One of the service users commented that bread and butter should have been available. There are service users of various cultural backgrounds living at the home. The meals had been organised so that Asian meals were available at teatime. The menus inspected showed that there was a dhal or vegetable dish and chappati or bread and butter available. The four week menu seen did not indicate that there were any Asian meat dishes available although the food records did occasionally record that one individual was having chicken and rice. One person commented that they were never cooked lamb only chicken. In discussions with some of the Asian service users it was noted that there were no items such as yoghurt, salad, pickle etc available at the mealtimes. There was no evidence of items such as parathas being offered or Indian tea being made available. The home needed to liaise with the service users and their families in order to get information about dietary preferences and likes and dislikes and offer more choice regarding the Asian meals. There were a variety of items available at lunchtimes and at teatime there was a choice for sandwiches or another item for those not taking an Asian meal. There was no choice for service users taking an Asian meal at teatime. Examinations of these menus showed that sausage rolls were on the menu two evenings and on Sundays the choice was assorted sandwiches or sandwiches. The home needed to ensure that there was a real choice in the items available. The menus also needed to identify the vegetables on offer and the desserts available. During discussions with the kitchen staff it became evident that the Asian meals were being cooked on one day of the week and then being frozen and then used throughout the rest of the week. The only reason for this was that the member of staff only had sufficient hours on one day to undertake this cooking. The hours available and being worked needed to be discussed so that the residents could have meals that were freshly cooked as the other service users meals were being cooked. Ruksar DS0000017194.V307138.R01.S.doc Version 5.2 Page 16 During lunchtime the inspectors observed that staff were appropriately seated to assist those people requiring assistance, however, the desserts were placed on the tables before anyone had finished their first course. This can give the impression that the aim is to get the meal over and done as quickly as possible and can encourage some residents to leave their first course and eat only the dessert. All meals were plated up in the kitchen and brought into the dining room on a trolley. The plates were covered however, one person commented to the inspector that sometimes the food was not hot enough and they had to have it heated up in the microwave. The home needs to ensure that meals are served at appropriate temperatures and have systems in place to ensure that the meals that are transported around the home maintain the temperature of the meals. The home also needed to look at ways in which the individuals were enabled to make positive choices of the food they wanted, for example, have food placed on tables for the people to assist themselves where possible. The home had information available in the kitchen for service users who had specific dietary needs and how these could be met. Soft diets were being prepared in the home and it was good that the food was not presented as mixture of all the items but individually softened. There was good practice observed by putting pictures of some of the items available on the menu board in the dining room. Ruksar DS0000017194.V307138.R01.S.doc Version 5.2 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): OP 16,18. YA 22,23 Quality in this 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, some residents are not confident that their concerns will be listened to, taken seriously or acted upon. EVIDENCE: The home has a complaint procedure and was last reviewed August 2006, a copy of which is displayed at the entrance to the home. A log is maintained of complaints/concerns received that last entry being 27/03/06 One service user stated that a complaint has recently been raised and the owner and manager were aware of the complaint. There was no evidence of this complaint in the complaint record. No complaints/concerns have been raised directly with the commission since the last inspection in May 2006. A copy of the nursing and midwifes council guidelines ‘The practitioner/client relationships and the prevention of abuse’ is available for staff reference in the main office. A copy of the multidisciplinary adult protection procedures is also available for staff reference. Ruksar DS0000017194.V307138.R01.S.doc Version 5.2 Page 18 The procedure for dealing with the safe keeping of service users personal monies remains unchanged with records of all transactions being made, receipts are kept and whenever possible the signature of service user is obtained. One person was sat all day in a chair in the lounge with a hospital-type table put in front of her. Staff stated that this was due to the fact that if she tried to get up she would fall. The table was placed so that she could not remove the table. This could be seen as a form of restraint. There was no risk assessment or agreements in place to state that this practice had been found to be necessary and agreed with significant others. Ruksar DS0000017194.V307138.R01.S.doc Version 5.2 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): OP 19,21,25, 26. YA 24,30 Quality in this area is adequate. This judgement has been made using available evidence including a visit to this service. Environmental improvements are being actioned in order to provide service users with a more comfortable home to live. It has a rolling programme to improve the decoration, fixtures and fittings, but intermittently there is slippage of the timescales EVIDENCE: Ruksar DS0000017194.V307138.R01.S.doc Version 5.2 Page 20 The programme for the renewal of the fabric and fittings continues, floor coverings in some of the private areas of the home have been replaced to a more suitable and appropriate type. Some curtains and items of bedroom furniture had been replaced. In the main sitting area it was noted that a number of the light bulbs need replacing (this was highlighted in the report of the inspection of May 2005). The parker bath in the ground floor bathroom continues to have problems with adequate drainage. The laundry door was being held open with the use of a wooden wedge. A sluice disinfector has been installed on the ground floor and is now in working order. The shower room still requires some attention, the shower head was leaking, the shower door is broken, the shower tray is very marked and stained and the floor tiles are in need of a thorough clean. The battery in smoke detector in the lift was bleeping and requires changing. Service users spoken with during the tour of the premises stated that their bedrooms were ‘not too bad’ and ‘quite comfortable’. Ruksar DS0000017194.V307138.R01.S.doc Version 5.2 Page 21 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): OP 27,28,29,30. YA 32,34,35 Quality in this area is poor. This judgement has been made using available evidence including a visit to this service. The home is failing to maintain an adequate number of staff at all times, consequently not all care needs of people living at the home are being met. Processes which promote the well being of service users and staff competence (such as care planning, reviews, staff supervision and appraisals) are also not being undertaken, leading to shortfalls in the safety and standard of care provided at the home. EVIDENCE: A first level nurse was in charge of the premises supported by three care staff and additional ancillary personnel. The nurse in charge stated that at times there are two first level nurses on the premises mainly when the manager is on duty. Service users were only receiving the very basic of care; the staffing levels did not appear to meet the needs of the residents. Staff appeared to be very busy Ruksar DS0000017194.V307138.R01.S.doc Version 5.2 Page 22 and rushed, and throughout the time of the inspection very little interaction or recreational activity happening. The home needs to ensure that there are additional staffs hours made available to enable the social and recreational needs of all service users to be fully met and all meals to be cooked on a daily basis. The cook continues to arrange social activities for one resident and limited and sporadic activities for the other people, no additional time is allocated to her for this additional role. A training file has been developed and contains the information on each individual member of staff of the training undertaken or planned for during the year. The copious amounts of information was very difficult to assess, a training matrix would assist with ease the identification of the training and development needs of the individual. The person in charge confirmed that training in diabetes awareness, adult protection and mental health topics had been arranged. Three staff personnel files were selected for inspection each contained a completed application form. One did not contain references, or a criminal record bureau disclosure requested by the home. One file did not contain a current personal identification number (PIN) of the Nursing and Midwifery Council to enable a person to work as a registered nurse. The owner confirmed that this person did have a current PIN; later during the inspection a copy of the PIN was found (it had been wrongly filed). The three files did not contain any evidence of induction training. Ruksar DS0000017194.V307138.R01.S.doc Version 5.2 Page 23 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): OP 31,33,35,36,38. YA 37,39,42 Quality in this area is adequate. This judgement has been made using available evidence including a visit to this service. The home is currently experiencing a period of instability due to changes in the management structure and is not operating in the best interests of people living at the home. Ruksar DS0000017194.V307138.R01.S.doc Version 5.2 Page 24 EVIDENCE: An existing member of staff has been identified for the position of registered manager, the formal application has been submitted and is currently being processed. Quality assurance monitoring continues with service users satisfaction questionnaires being distributed in August 2006, the results have yet to be fully audited. One questionnaire completed and returned made an additional comment of ‘ I’m very happy here, I got everything I want’. However another service user in discussion stated how unhappy they felt with living at the home and stated ‘it is not the place for me and I wish to move somewhere else’. A review of this persons care had recently been carried out with the social worker and staff at the home. Monthly staff and service users meetings continue to be arranged with minutes taken of the content of the meetings. The procedure for dealing with the safe keeping of service users personal monies remains unchanged with records of all transactions being made, receipts are kept and whenever possible the signature of service user is obtained. The owner stated that staff are receiving regular supervision and annual appraisals with their line manager however the recording sheets were not available for inspection. The three personnel files contained only one supervision record dated 28/07/06. Health and safety checks for the premises and equipment continue with records maintained. Assessments for the safe use of chemicals (COSHH) have been carried out by the cook and contain a risk assessment and information data sheets. The cook stated that a main file is kept in the kitchen with each area having a separate file pertaining to the chemicals in use. Fire safety testing is conducted each week, however the fire risk assessment for the premises is dated February 2005 and is due for revision. Routine inspections continue for the safe use of the bedrails, no records were available for the routine maintenance checks for the wheelchairs. Ruksar DS0000017194.V307138.R01.S.doc Version 5.2 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 X 2 X 3 2 4 X 5 X 6 N/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 ENVIRONMENT Standard No Score 19 2 20 X 21 2 22 X 23 X 24 X 25 2 26 3 STAFFING Standard No Score 27 1 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No Score 31 3 32 X 33 2 34 X 35 3 36 2 37 X 38 2 Ruksar DS0000017194.V307138.R01.S.doc Version 5.2 Page 26 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 31/10/06 service user guide must be reviewed and updated to contain current and accurate information of the service provision. Previous timescale of 31/07/06. Not fully assessed on this occasion. A full and detailed 30/09/06 assessment of need must be undertaken prior to a person moving into the home. The service users plan of care 30/09/06 must accurately detail and record all assessed needs. Previous requirement 01/01/06 and 21/04/06 Not met Moving and handling, 31/10/06 nutritional screening and falls risk assessments must be completed for all service users, the findings actioned and reviewed at regular intervals. The registered person must 30/09/06 ensure that procedures are in place for the regular auditing of the medication to ensure Version 5.2 Page 27 Requirement 2 OP3 14(1) 3 OP7 15(1)(2) 4 OP8 17(1) Schedule 3(o) 5 OP9 13(2) Ruksar DS0000017194.V307138.R01.S.doc 6 OP9 13(2) 7 OP9 13(2) 8 OP12 16(2)(m)(n) 9 OP14 12(2) 10 OP15 16(2)(i) 11 OP15 12(1) the integrity of the MAR charts and the consistency of the medication supply is maintained. Previous timescale 06/05/06 not fully met. Products that have a short shelf life when opened must be dated upon opening and discarded after the specified time period. Previous timescale 06/05/06 not fully met. The registered person must ensure that protocols are available for staff information in regard to the use of when required medications. The registered person must ensure that all service users are offered the opportunity for stimulation through leisure and recreational activities and cultural interests. Previous timescale 30/06/06 not fully met. The registered person must ensure that service users are assisted and encouraged to exercise choice and control over their lives. The registered person must ensure that all meals are presented in a manner that is attractive and appealing in terms of texture, flavour and appearance. Previous timescale 01/04/06 Not met The registered person must ensure that staff are instructed to offer assistance to service users with their meals in a discreet, appropriate and unhurried manner. DS0000017194.V307138.R01.S.doc 30/09/06 31/10/06 30/09/06 30/09/06 30/09/06 30/09/06 Ruksar Version 5.2 Page 28 12 OP15 12(4)(b) 13 OP15 12(4)(b) 14 OP15 17(2) Schedule 4(13) The registered person must ensure that service users are offered a true choice of food at all times to meet their cultural dietary needs. The registered person must address and promote equality and diversity in the provision of meals and adopt procedures to ensure that a persons’ cultural need is fully met. The records of food provided to service users must be in sufficient detail to enable any person inspecting the record to determine whether the diet is satisfactory, in relation to nutrition and to include any special diets that are prepared for individual service users. The registered person must ensure that all complaints/ concerns raised are taken seriously, acted upon and recorded. The registered person must ensure that systems are in place to protect vulnerable people from potential or actual abuse. The registered person must ensure that the appropriate door closures (linked into the fire alarm system) are fitted to doors where there is a need or preference for the doors to remain open. The leaking shower on the first floor must be repaired and fit for the purpose. The shower door must be repaired; the tray and the floor tiles must be thoroughly cleaned. 30/09/06 30/09/06 31/10/06 15 OP16 22(7)(a)(b) 30/09/06 16 OP18 12(1)(a) 30/09/06 17 OP19 23(4) 30/09/06 18 OP21 23(2)(b)(c)(d) 30/09/06 Ruksar DS0000017194.V307138.R01.S.doc Version 5.2 Page 29 19 OP25 Previous timescale 30/06/06 not fully met. 23(1)(a)(2)(p) Lighting in service user accommodation must meet recognised standards (lux 150). Previous timescale 21/04/06 and 30/06/06 Not met 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 not met. 18(1)(a) The registered person must ensure that catering staff are employed in sufficient number to ensure that standards relating to food, meals and nutrition are fully met. 18(1) The registered person must ensure that the training plan/ matrix indicates the training and development needs of staff. 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 Schedule 2 of the regulations Previous timescale 30/06/06 not fully met. 18(1)(a) The registered person must ensure that all staff receive an induction programme that meets the Skills for Care specifications. Previous timescale 30/06/06 not fully met. DS0000017194.V307138.R01.S.doc 30/09/06 20 OP27 30/09/06 21 OP27 31/10/06 22 OP28 31/10/06 23 OP29 30/09/06 24 OP30 30/09/06 Ruksar Version 5.2 Page 30 25 OP33 24(1)(a)(b) 26 OP33 24(1)(2) 27 OP36 18(2) 28 OP38 12,13 29 OP38 23(4) The registered person must ensure that systems are in place for the effective monitoring of the quality of the service provided. The results of service user surveys must be published and made available to service users, interested parties and the commission. Previous timescale 31/08/06 not fully met. The registered person must ensure that all staff must receive regular formal and recorded supervision with their line manager at least six times per year. Previous timescale 30/06/06 not fully met. Records for the servicing of all equipment must be available for inspection. Previous timescale 30/06/06 not fully met. The registered person must ensure that a fire risk assessment for the premises is completed and reviewed on a regular basis. 31/10/06 30/09/06 30/09/06 30/09/06 31/10/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP9 Good Practice Recommendations It is recommended that external medication within tubs be discarded 28 days after opening. Ruksar DS0000017194.V307138.R01.S.doc Version 5.2 Page 31 Ruksar DS0000017194.V307138.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Shrewsbury Local Office 1st Floor, Chapter House South Abbey Lawn Abbey Foregate SHREWSBURY SY2 5DE 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. 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