Inspection on 07/04/09 for Rushey Mead Manor

This inspection was carried out on 7th April 2009.

CQC found this care home to be providing an Poor service.

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

Rushey Mead Manor 05/10/09

Rushey Mead Manor 14/01/09

Rushey Mead Manor 10/09/08

Rushey Mead Manor 02/10/07

Rushey Mead Manor 12/12/06

Rushey Mead Manor 03/05/06

Rushey Mead Manor 18/10/05

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2010.

Key inspection report CARE HOMES FOR OLDER PEOPLE Rushey Mead Manor 30 Coatbridge Avenue Rushey Mead Leicester LE4 7ZS Lead Inspector Diane Butler Unannounced Inspection 7th April 2009 09:30 DS0000064260.V374907.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Rushey Mead Manor DS0000064260.V374907.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Rushey Mead Manor DS0000064260.V374907.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Rushey Mead Manor Address 30 Coatbridge Avenue Rushey Mead Leicester LE4 7ZS 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) 0116 2666606 0116 2660708 Midland Healthcare Ltd Manager post vacant Care Home 40 Category(ies) of Dementia (17), Mental disorder, excluding registration, with number learning disability or dementia (17), Old age, of places not falling within any other category (40), Physical disability over 65 years of age (5) Rushey Mead Manor DS0000064260.V374907.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. No one falling within category OP may be admitted into Rushey Mead Manor where there are 40 persons of category OP already accommodated within this home. No one falling within category PD(E) may be admitted into Rushey Mead Manor where there are 5 persons of category PD(E) already accommodated within the home. No person to be admitted to Rushey Mead Manor in categories MD or DE when 17 persons in total of these categories/combined categories are already accommodated in this home. No person to be admitted to Rushey Mead Manor in categories OP, PD(E), DE or MD when 40 persons in total of these categories/combined categories are already accommodated in this home. No person who requires nursing care are to be admitted into Rushey Mead Manor in categories OP, DE, MD or PD(E) when 20 persons in total of categories/combined categories are already accommodated in this home. 14th January 2009 5. Date of last inspection Brief Description of the Service: Rushey Mead Manor is registered to accommodate forty older people in need of residential or nursing care. The home has a multicultural service user group and the staff team is also multicultural. Both English and Asian diets are catered for. There is a small temple and chapel situated in the building. Accommodation is on three floors with a lift and stairs for access. There are thirty-eight single bedrooms and one double bedroom. Two of the single bedrooms and the double bedroom have ensuite facilities. There are five lounges, two dining rooms, and one smoking room. The home is situated close to Leicester City Centre with good transport links and other local amenities. Current charges range from £331.00 to £550.00 depending on care needs and additional charges are in place for personal items such as newspapers, toiletries, and chiropody treatment. Details of what additional charges service users can expect to pay can be found in the service user guide, which is given to everyone living in the home either prior to, or on arrival at Rushey Mead Manor. A copy of the latest Inspection report is available at the home, or it can be accessed via the CQC website: www.cqc.org.uk. Rushey Mead Manor DS0000064260.V374907.R01.S.doc Version 5.2 Page 5 Further information about the home is available from the acting manager. Rushey Mead Manor DS0000064260.V374907.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use the service experience poor outcomes. This key inspection took place over one day in April 2009. We (the Care Quality Commission or ‘CQC’) arrived at the home on Tuesday 7th March at 9.30am and completed the visit at 5.15pm. The inspection was unannounced and this means the service was not aware that we were coming. When undertaking key inspections CQC focuses on the outcomes for people receiving a service. In order to do this we case tracked three people receiving care and support. This means we checked records, spoke with them where possible and spoke to relatives who were visiting on the day and the care workers providing the care and support. Where communication was difficult observation was used to evidence whether care needs were being met. Surveys were sent to ten people living at the service and their relatives and ten members of staff to gather further views of the home and the service provided. Four surveys were received from people living at the service and their relatives and three staff surveys had been returned prior to this report being written. Comments received in the surveys returned included: Users of the service and relative Comments “Staff at this home are friendly and approachable, they always try to help out”. “Usually staff are available when asked for”. “Activities are arranged very occasionally”. “Meals are usually good”. “The home is usually reasonably clean”. “Toilets dirty, toilets do not flush very well, urine on carpets in lounge, very smelly, light switches dirty, seats dirty”. “The home manager was very helpful and still is”. Rushey Mead Manor DS0000064260.V374907.R01.S.doc Version 5.2 Page 7 “We have always had to prompt the staff to take action, say if ill or needs doctors appointment, we have to request this, but having said this matters have improved and recently care and support is much better”. “Although in the home brochure it said activities take place I have never seen any and the residents usually just sit around. It would be good to have an activity coordinator and some time spent getting the residents to do something”. “All the staff are approachable”. “The only place that could be cleaner is the dining room, the chairs and tables need to be cleaned and wiped daily. Many times the tables are dirty from the last sitting, usually breakfast, otherwise the home is adequate”. Staff Comments “We are gaining a lot through the training that we are doing”. “I listen to any problem and help when ever I can but I inform the manager on duty about the concern and inform the service user what I have done to try and help and document everything”. “I am happy, manager is very good”. “The reason the service does well is because they have good support, good management, good knowledge and understanding and shows good morale and respect”. “The only thing I would like the service to do better is allow the residents to go out to day trips or outings”. Further planning for the inspection visit included checking the service history of the service and last Inspection report and looking through the AQAA document (Annual Quality Assurance Assessment), which was submitted to the CQC prior to the visit. The AQAA document is the main way that providers inform us of how well their service is delivering outcomes for the people using it. We checked all the standards that the CQC have decided are key standards during this inspection. The information below is based only on what we checked in this inspection. We have kept details about individual people out of the report to make sure we respected their confidences. Rushey Mead Manor DS0000064260.V374907.R01.S.doc Version 5.2 Page 8 What the service does well: People’s needs are assessed before they move into the home to ensure that they can be met. Two menus are offered on a daily basis, one Asian, one English. Both menus offer a choice at every mealtime and meals can be taken ether in the main dining area, one of the lounges within the home or in the person’s own room. People living in the home are treated with dignity and respect at all times and care workers support them to be as independent as possible. Visiting is strongly encouraged; visitors are always made welcome and made to feel part of the home. All staff, including cleaning and catering staff, have the opportunity to obtain National Vocational Qualifications. Further training has been sourced to ensure that staff are appropriately trained and knowledgeable in the care and support they are expected to provide. What has improved since the last inspection? What they could do better: Ensure that the care plans are accurate and kept up to date. Nurses and care workers need to have up to date information to enable them to care properly for the people in their care. Rushey Mead Manor DS0000064260.V374907.R01.S.doc Version 5.2 Page 9 Ensure that when risks are identified, the actions that the staff are expected to take to reduce the risk is contained within the risk assessment documentation. Nurses and care workers need to be aware of all the current risks to the people in their care and the actions to take to minimise those risks. Ensure that daily records accurately reflect the care given to people living in the home and these are easy to understand. People’s health and care needs need to be accurately monitored and updated when necessary. Ensure that peoples personal preferences in daily living are sought and included in the care plan documentation. People’s choices and preferences must be promoted and met wherever possible. Ensure that when a person has been identified as at risk of dehydration/ malnutrition that the dietician is involved in their care. Staff should not take it upon themselves to give prescribed supplement drink, but should take advice from the relevant professional people to ensure individual nutritional needs are met. Ensure that all prescribed medication is available and given as and when prescribed. People are at risk if their prescribed medication is not available. Ensure that the identified work as highlighted in the decoration schedule is completed in a timely manner and all parts of the home are kept clean and free form offensive odours. People living in the home must be provided with a comfortable and homely place to live. Provide information in different formats to take account of the different languages spoken by people living in the home and the communication difficulties that some people may experience because of dementia. Promote people’s dignity and choice within daily living whenever possible. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Rushey Mead Manor DS0000064260.V374907.R01.S.doc Version 5.2 Page 10 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 Rushey Mead Manor DS0000064260.V374907.R01.S.doc Version 5.2 Page 11 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,5 6 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The needs of the people moving into the home are assessed to ensure that they can be met. EVIDENCE: A statement of purpose and service user guide is in place and is available to people interested in living at the home. These documents include information on the aims and objectives of the home, charges made for services provided and details of how to make a complaint should someone be unhappy about something. These documents have yet to be produced in other languages or formats as recommended at the last visit. Rushey Mead Manor DS0000064260.V374907.R01.S.doc Version 5.2 Page 12 If these documents were made available in other formats or languages it would enable the provider to meet the diverse needs of the people, both living in the home and interested in living in the home. A brochure informing people about the home is available and this is available in Gudjarati or English. The statement of purpose and service user guide still refer to the acting manager as the manager and should be amended until such a time as they are registered with the Care Quality Commission. Signed Terms and Conditions were in place for the people whose records we checked. People who are interested in living in the home are invited to look around to see what facilities are available and whether it would be the right place for them to live. One relative spoken with explained that they had visited the home prior to their relative moving in. We were told “We came to see the home first and liked it before moving in”. The acting manager explained that all prospective users of the service are assessed prior to moving in or in the event of an emergency on the day of their arrival to ensure that their care and support needs can be met. A needs assessment is completed and an assessment of need is also obtained from the person’s social worker. Appropriate assessments were in place in the records checked. Intermediate care is not currently provided at Rushey Mead Manor. Rushey Mead Manor DS0000064260.V374907.R01.S.doc Version 5.2 Page 13 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Lack of accurate records result in the needs of the people living at the home not being met. Delays in obtaining peoples medication puts them at risk. EVIDENCE: We looked at three peoples care records. We directly observed the care and support those people received and spoke with staff to gain their knowledge of the care and support they were expected to provide. Care plans are developed for each person living in the home. These are based on the information obtained during the assessment process. Care plans were included in the files we checked, though not all were up to date or accurate. The daily records belonging to one person living in the home showed that a Rushey Mead Manor DS0000064260.V374907.R01.S.doc Version 5.2 Page 14 small grade 1 pressure sore had been identified and subsequently attended to. We looked at their pressure area care plan to see that this information was not included. It gave no details of the pressure sore, when and how often it should be dressed and what dressings should be used. It was recommended at the last visit that regular checks are carried out on all airwave mattresses. These are used when someone is at risk of developing pressure sores. On checking the information for one person in the home the care plan stated that the mattress should be ‘set at body weight 5’, on checking the mattress it was set at 5.5. For another person living in the home the care plan stated ‘ensure at correct setting’, though no record was made of what this should be. No regular checks are carried out or recorded to show that this equipment is regularly checked or working appropriately to meet the pressure care needs of the person. On admission a nutritional screening tool and body mass index chart (BMI) are completed to identify whether the person is nutritionally at risk. Following this a nutrition and fluid chart is developed which is completed each time the person has food or drink. Not all of these records were up to date. For one person the nutritional screening tool and BMI chart had been completed on arrival and showed a high risk. These forms had not been completed since, even though it was evident that changes in weight had occurred. Had the BMI chart been completed this would have shown that the person had moved into a different category within the tool. One person had been identified as losing weight and a referral had been made to the dietician though again these forms were not routinely reviewed. Nutrition and fluid charts are used to monitor food and fluid intake when people are assessed as at risk of dehydration and/or malnutrition. The forms we looked at were not up to date and did not show what people had eaten or drunk throughout the day. One persons record showed that on 11/03/09 no fluids had been given until 2.15pm and no food had been given until 5.00pm when they were given curry, chapatti and ice cream. On 22/03/09 the records showed that they had been given no fluids or food all day. The acting manager stated that the person would have been provided food and drink but staff had failed to record this. One person’s fluid chart showed that they had been given fortisip, a prescribed supplement drink, on an adhoc basis. No mention of this was included in their nutritional care plan and the medication records showed that this was not being prescribed for that person. The acting manager stated that they had a bulk supply of the supplement drink and had given it when it was felt the person needed it. The dietician had not been involved in this person’s nutritional care. Rushey Mead Manor DS0000064260.V374907.R01.S.doc Version 5.2 Page 15 Risk assessments were in place however, not all included the specific actions to be taken by staff to minimise the risk presented to the person or them selves. We checked the medication records of two people living in the home. Medication records were in order with a signature for each medication given. The nurse on duty was observed giving people their medication at lunchtime, this was carried out discreetly and without interruption. Controlled medication was being appropriately stored, with accurate records in place. One persons medication records showed that two medicines had not been given, due to them being out of stock. One medicine, which was prescribed once a day, had not been given for 3 days and another medicine, which was prescribed twice a day, had not been given for 7.5 days. We spoke to the nurse and acting manager about this. We were told that a prescription request had been sent to the GP surgery, but no evidence was seen to suggest that this had been followed up. People who are unable to stand or move are assisted with the help of two carers and a hoist. Each person has his or her own sling, which is appropriate to his or her weight and height. Throughout the visit we saw that it was common practice for people to sit all day with their sling around them. This was confirmed by one of the care workers who explained that they are placed around them in the morning and taken off again in the evening. One persons sling had not been loosened from the previous transfer and was still strapped tightly around them. This practice was not included in their care plan and no evidence of them having a choice was seen. People should be given the opportunity for the sling to be removed after each transfer to further promote their dignity. People spoken with told us that they were well cared for and a relative spoken with told us that they were satisfied with the care their relative was receiving. They said “The girls are good, xxx has a bath every day, xxx mostly looks clean, but some days not so”. Throughout the visit staff were seen speaking to people in a respectful manner and providing care and support in an unhurried, relaxed and friendly way. Rushey Mead Manor DS0000064260.V374907.R01.S.doc Version 5.2 Page 16 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People enjoy a varied diet, which meets their individual needs. People’s nutritional needs are not always met due to lack of accurate nutritional recording. A more varied activity programme would provide a more stimulating environment for the people living there. EVIDENCE: People living in the home are offered choices daily, these include when to get up and what to wear, where and how they wish to spend their time during the day and what and when to eat. Specific religious and cultural needs are met. A cultural needs assessment is completed either prior to moving into the home or on admission to the home and preferences in daily living are on the whole identified and supported, Rushey Mead Manor DS0000064260.V374907.R01.S.doc Version 5.2 Page 17 though one person explained that they didn’t drink tea, as only English tea was offered not Masalla tea, which they preferred. We were told that care staff provide activities twice a day. No activities were provided on the day of the visit but the staff routinely provide some activities. This includes games of skittles and ball games. A Pat dog visits once every two weeks and craft classes are run alternate weeks. Items recently made include flower baskets and Easter cards. People living at the home have access to Sky television, providing Asian channels in one of the lounges whilst English channels are available in another lounge. On the day of the visit the majority of people living there were sat in the lounges watching television or sleeping, one relative explained, “I am satisfied with the care they receive but they do spend a lot of time on their own”. There are two cooks and two menus are offered on a daily basis, one Asian, one English. Both menus offer a choice at every mealtime and the meals served on the day of the visit looked nutritious, appealing and hot. The menu on the day of the visit offered Chicken pie with vegetables and aubergine curry with toor dhal, chapatti and rice. People who require special diets such as diabetic, soft or liquidised diets are catered for and supplements are provided if needed. When preparing a soft or liquidised meal, the cooks ensure that each item is liquidised separately, not altogether, making the meal look more appealing. Nutrition and fluid charts should be completed to ensure that people receive the nutrition they need, however of the three charts checked on the day of the visit, two were not completed correctly, with one having no record of food or drink given. Visiting is encouraged. Relatives and friends were visiting throughout the day and they told us that they were able to visit at any time and were always made welcome. We were told “I come every day, the staff are good”. Rushey Mead Manor DS0000064260.V374907.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffs understanding of safeguarding procedures ensures that the people living in the home are kept from harm. EVIDENCE: There is a complaints procedure in place, though this is not currently available in any other language than English. A copy of this is displayed in the reception area of the home and a copy is included in the service user guide, which is given to everyone who moves into the home. To ensure it is widely accessible this should be made available in alternative formats, including alternative languages for those whose first language is not English. One relative spoken with during our visit told us that she felt that her relative was safe living in the home and any concerns that she had, she would raise with the management team. We were told that no complaints had been received since the last inspection visit in January this year. We confirmed this by checking the complaints file. Rushey Mead Manor DS0000064260.V374907.R01.S.doc Version 5.2 Page 19 Staff records showed that appropriate checks had been carried out before staff commenced work, to ensure they were suitable to work with those living in the home. The majority of staff have received training in the ‘safeguarding of vulnerable adults’ and the acting manager is booked to attend a further training course on this subject in May this year. One staff member who has worked at the home for approximately one month explained that she had yet to receive this training but when asked, showed us that she had a good understanding of her responsibilities should she suspect anyone of abuse or misconduct. The staff we spoke with during the visit knew what was expected of them if they suspected any form of abuse and all stated that they would report their concerns immediately to management or higher if needed. Rushey Mead Manor DS0000064260.V374907.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19,23,24,26 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Further improvements planned for the environment will ensure that the people living in the home are provided with a clean, comfortable and safe place to live. EVIDENCE: Accommodation at Rushey Mead Manor is provided on three floors. Some parts of the home are currently not in use, including a second kitchen, lounge area and a number of bedrooms on the first floor. These areas have now been made secure as required at the last visit, with access only available to staff. Rushey Mead Manor DS0000064260.V374907.R01.S.doc Version 5.2 Page 21 Work has been carried out since our last visit to improve some of the homes environment. This includes the redecoration of a number of communal areas including the ladies downstairs toilet, the main dining area and the redecoration and retiling of the main kitchen. The flooring has been replaced in the medical room and the smoking room and new soap and towel dispensers have been purchased and installed. A number of improvements have yet to be completed and a decoration schedule was received following this visit informing us of the remaining work to be carried out to address the shortfalls identified. This includes clearing the garden of rubbish, cleaning and tiding the patio outside the dining room, steam cleaning hard surfaces and floorings, including the men’s toilets opposite the office and the back area by the stairs leading to the staffroom and smoke room. The downstairs bathroom was in need of attention and we were informed that this was ‘a work in progress’ and this, along with the other bathrooms, were due to be redecorated between July and August this year. All communal areas of the home were clean and tidy but there was a smell of urine present in the reception area and the curtain in one of the lounges was hanging off the rail. On the day of the visit a health and safety consultant was in attendance. They informed us that they had been asked to complete a thorough health and safety assessment of the home and it is the provider’s intention to act on the recommendations made. During the visit we were invited to look at a number of bedrooms. Two of those seen had not been personalised in anyway. There were no pictures on the walls, no photographs, no ornaments, or anything to suggest that they were permanently occupied. This was discussed with the acting manager who explained that she would encourage and assist people to personalise their own rooms if they so wished. Rushey Mead Manor DS0000064260.V374907.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Current recruitment practices ensure that the people living in the home are safe. EVIDENCE: Staffing levels currently provide a registered nurse and four care workers on duty during the day and one registered nurse and two care workers provide night time support. We spoke to staff on duty during the visit and they told us that there were generally enough staff on to meet the current needs of the people living at Rushey Mead Manor, though one care worker shared that they could “always do with more staff”. An appropriate recruitment process is followed, with the necessary checks being carried out before someone starts work at the home. This ensures that staff are suitable to provide care and support to the people living there. These checks include suitable references and police checks. Rushey Mead Manor DS0000064260.V374907.R01.S.doc Version 5.2 Page 23 The provider also checks the personal identification number or ‘PIN’ of each registered nurse employed to ensure that they are suitably qualified to provide the nursing care required. We were told that all new staff complete formal ‘first steps’ induction training, this was confirmed whilst checking staff files and on speaking with care workers on duty during the visit. A number of training courses have been provided since our last visit in January this year. Care workers have been provided with moving and handling training, Safeguarding of Vulnerable Adults training, fire safety training and health and safety training. The acting manager has also sourced further distance-learning training from North Warwickshire College who will provide training in dementia, healthy eating, palliative care and medication training. The acting manager is due to attend ‘Part B’ of a safeguarding training course which will enable her to provide this to all the staff in the home and training in the safe administration of medication is also being provided for those responsible for the administration of medication. Some staff have received supervision sessions and the acting manager is planning to provide these to all staff throughout the coming year. Rushey Mead Manor DS0000064260.V374907.R01.S.doc Version 5.2 Page 24 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health, safety and welfare of the people living in the home is not always promoted or protected. EVIDENCE: The acting manager has been in post since April 2008. An application was recently submitted to the Commission for registration, however this has since been withdrawn. She is a registered nurse and has seventeen years experience in care management. She has recently attended training in several key areas, including safeguarding and implementation of the Mental Capacity Act. Rushey Mead Manor DS0000064260.V374907.R01.S.doc Version 5.2 Page 25 Training in Health and Safety is arranged for 28th April and further training in safeguarding vulnerable adults has been arranged for 5th and 6th May, which will enable her to cascade this training to the rest of the staff team. We were told that the acting manager was always available for help and advice should staff need it. One care worker explained “The manager [acting] is very approachable, I look up to her big time”. We looked at money held on behalf of one person living in the home. Accurate records were being kept, receipts were always obtained and the signatures of those involved in any transaction were obtained. We looked at a number of records during the day, not all of them were up to date or accurate. These included personal care records for the prevention of pressure sores and dehydration. These shortfalls were also identified at the previous two visits. On a number of occasions entries in the daily records were not easy to read and we needed to ask the acting manager to confirm their contents. This was discussed with the acting manager as this could potentially have an affect on the care and support provided. Quality Assurance surveys have been developed, these had been sent to relatives of the service users and three had been returned to the acting manager by the time this visit was carried out. All three showed satisfaction with the service provided. Further work is needed to involve the people living in the home or of other stakeholders such as commissioning social workers. A fire risk assessment has recently been completed by an appropriate outside company and a Health and Safety assessment was being completed on the day of the visit to ensure that health and safety is adhered too in the future. Rushey Mead Manor DS0000064260.V374907.R01.S.doc Version 5.2 Page 26 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 2 3 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 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 X 18 3 2 X X X 2 2 X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 1 Rushey Mead Manor DS0000064260.V374907.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15(2)(b) Requirement The registered person shall: Keep the service users plan under review. The registered person must ensure that care plans and associated documents are accurate and up to date. Nurses and care workers need to have up to date information to enable them to care properly for the people in their care. Previous time scale of 28/02/09 was not met. The registered person must ensure that daily records accurately reflect the care given to people living in the home. This is to ensure that people’s health and care needs can be accurately monitored and updated when necessary. Previous timescales of 06/02/09 not met. Rushey Mead Manor DS0000064260.V374907.R01.S.doc Version 5.2 Page 28 Timescale for action 30/04/09 2 OP7 17 30/04/09 3 OP7 15(1) The registered person shall 24/04/09 prepare a written plan as to how the service users needs are to be met. The registered person must ensure that peoples personal preferences in daily living are sought and included in the care plan documentation. People’s choices and preferences must be promoted and met wherever possible. The registered person shall ensure that: Unnecessary risks to the health or safety of service users are identified and so far as possible eliminated. The registered person must ensure that risk assessments contain the specific actions to be taken to minimise any risk identified. Care workers need to be aware of all the current risks presented to the people in their care and the actions to take to minimise those risks. 4 OP8 13(4)(C) 24/04/09 5 OP8 13(b) The registered person shall make 24/04/09 arrangements for service usersTo receive where necessary, treatment, advice and other services from any health care professional. The registered person must ensure that when a person has been identified as at risk of dehydration/malnutrition that the dietician is involved in their care. Rushey Mead Manor DS0000064260.V374907.R01.S.doc Version 5.2 Page 29 6 OP9 13 (2) People’s nutritional needs must be met. The registered person shall make 24/04/09 arrangements for the recording, handling, safe keeping, safe administration and disposal of medicines received into the care home. The registered person must ensure that people are only given supplements when prescribed to them. This will ensure that the relevant professional person is involved in the persons care. The registered person must ensure that all prescribed medication is available and given as and when prescribed. People are at risk if their prescribed medication is not available. 7 OP19 23(2)(b) (d) The registered person shall 30/06/09 having regard to the number and needs of the service users ensure thatThe premises to be used are kept in a good state of repair externally and internally. All parts of the care home are kept clean and reasonably decorated. The registered person must ensure that service users are provided with a comfortable and homely place to live. Previous timescales of 01/12/08 and 31/03/09 not met. Rushey Mead Manor DS0000064260.V374907.R01.S.doc Version 5.2 Page 30 8 OP38 13(3) The registered person shall make 30/04/09 arrangements to prevent infection, toxic conditions and the spread of infection at the care home. The registered person must ensure that the premises are kept clean, hygienic and free form offensive odours. 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 OP1 Good Practice Recommendations The service users’ guide should be available in different formats to take account of the different languages spoken by people living in the home and the communication difficulties that some people may experience because of dementia. The information in the statement of purpose needs to accurately reflect the registration status of the current acting manager. It is recommended that a person’s body mass index should be calculated on the same day as the nutritional screening tool. A record should be made of the correct pressure for every person’s airwave mattresses and the pressure level should be checked on a daily basis. The registered person should ensure that where hoist slings are used these are removed if the person wishes to promote choice and dignity. The registered person should ensure that people are able to bring in their own possessions and personalise their rooms to suit themselves. A quality assurance system should be developed which seeks to gain the views of the all the people who live in the home, as well as the views of other stakeholders. These views should then inform the operation and development of the service 2. 3. 4. 5 6 7. OP1 OP8 OP8 OP10 OP14 OP33 Rushey Mead Manor DS0000064260.V374907.R01.S.doc Version 5.2 Page 31 Care Quality Commission Eastern Region Care Quality Commission Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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