CARE HOMES FOR OLDER PEOPLE
Ruskin Lodge Swinburne Road, Dentons Green St Helens Merseyside WA10 6AW Lead Inspector
Lynn Paterson Unannounced 23rd June 2005 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 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Ruskin Lodge F53 F03 S22408 Ruskin Lodge V235916 230605 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Ruskin Lodge Address Swinburne Road Dentons Green St Helens Merseyside WA10 6AW 01744 200100 01744 613081 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Pilkington Family Trust Mrs Diane Swift Care Home 23 Category(ies) of DE - 4 registration, with number OP - 13 of places PD - 6 Ruskin Lodge F53 F03 S22408 Ruskin Lodge V235916 230605 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Service users to include up to 13 (OP) and up to 4 (DE) and up to 6 (PD). 2. Total to include up to 5 service users under pensionable age. Date of last inspection 6th August 2004 Brief Description of the Service: Ruskin Lodge is owned and mangaged by Pilkinton Charitible Trust, its purpose being to provide short periods of respite for Pilkington pensioners and thier relatives. The premises is located in a quiet residential area of St.Helens which is approximatley one mile from St.Helens Town centre. Ruskin Lodge has 16 single and 3 twin rooms all with ensuite facility.Communial rooms include 2 lounge areas ,a pleasant roomy dining room,conservatory and large receptiohn hall .Visitors to the home are refered to as guests and the guest accomodation is situated on the ground and first floor with access provided from a passenegr lift and main stair well.The home has ample parking areas to the front of the building and overlooks spacious,well maintined grounds. Ruskin Lodge F53 F03 S22408 Ruskin Lodge V235916 230605 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection of Ruskin Lodge took place over a four and a half hour period and was carried out on an unannounced basis. For the purpose of this report the manager, 5 staff and 18 guests were spoken with and a full tour of the premises was undertaken. Care plans, staff rotas, policies, procedures, medication sheets and daily records were also examined and staff observed carrying out their duties. What the service does well: What has improved since the last inspection?
Staff advised that the home manager has developed procedures, which enhance the recording of information and has arranged more staff training and development to take place both in house and externally. Care plans have full details of pre admission information, followed by care planning and care delivery. Care plans show that they have been drawn up in
Ruskin Lodge F53 F03 S22408 Ruskin Lodge V235916 230605 Stage 4.doc Version 1.40 Page 6 consultation with the individual guest and abilities and preferences are discussed and recorded on file. The registered home manager has now settled into her role and staff advised that she is respected by staff and guests for her open approach to the home management. 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. Ruskin Lodge F53 F03 S22408 Ruskin Lodge V235916 230605 Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Ruskin Lodge F53 F03 S22408 Ruskin Lodge V235916 230605 Stage 4.doc Version 1.40 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 Pre admission assessments were thorough and held full details regarding individual need. EVIDENCE: Pre admission assessments examined revealed that all prospective guests of Ruskin Lodge received a full assessment of need prior to being offered a placement. Discussion with the manager and staff identified that this information was then reviewed and a decision was made as to the suitability of the placement. An example was given as to a request for a respite placement being refused as the home did not have the aids and adaptations which would have been necessary to meet the individual assessed need. Ruskin Lodge F53 F03 S22408 Ruskin Lodge V235916 230605 Stage 4.doc Version 1.40 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7.8.9. Care plans are specific about care planning and show that they have been drawn up in consultation with the individual. Care plans have details of personal, social and health care needs and the care necessary to be given to meet the identified need. Medication records and administration was well managed at the time of the visit. EVIDENCE: Four care plans were examined in detail and showed that full information about care planning and individual care needs had been recorded on file and signed by the guest on each visit. Risk assessments were in place and medication records viewed were clear and consistent. The home had made sure that medication disclaimers were in place for guests who wished to self medicate and these were held in guests files and were updated on each respite visit as required. Guests spoken with said that they were fully consulted about all aspects of their care and staff, were fully knowledgeable about individual care needs. Guest’s comments included “the staff know exactly what we need to be done for us”, ”staff are kind and helpful”, ”the care we are given is second to none”, ”all care staff treat us with respect and look after us very well”.
Ruskin Lodge F53 F03 S22408 Ruskin Lodge V235916 230605 Stage 4.doc Version 1.40 Page 10 Staff advised that the care plans are implemented in consultation with each guest and the abilities and preferences are highlighted. Health care needs are recorded and any nursing need would be identified and arrangements put in place for district nursing visits to e made during the respite period. Ruskin Lodge F53 F03 S22408 Ruskin Lodge V235916 230605 Stage 4.doc Version 1.40 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12.15. Current activities and outings provide interests however guests feel that a more structured activities programme would enhance the respite periods. Menus are wholesome, food is plentiful, appetising and well presented in pleasant surroundings. EVIDENCE: The activities programme showed that activities were arranged but guests advised that they would like the activities to be more structured with “something going on each day and each evening”. Guests revealed that they wished that entertainment could be arranged each evening to enable them to sit relax and enjoy after their evening meal. Staff advised that they were aware that more activities should be provided and were in the process of devising an updated activities programme to meet that need. Guests spoken with commented that they felt they were on holiday in Ruskin Lodge and that the service provision was better than most hotels with the food being of the highest standard at all mealtimes and with snacks being served in between times. Guests comments included” we love coming here”,” it is so good here, much better than most hotels”, “ the food is wonderful”, “we have never had a bad meal here everything is so well cooked and presented”. Ruskin Lodge F53 F03 S22408 Ruskin Lodge V235916 230605 Stage 4.doc Version 1.40 Page 12 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16. Complaints procedures are in place to make sure that staff and guests are confident that any complaints will be handled quickly in a dignified and sensitive manor. EVIDENCE: The complaints procedure in the home was clear and gave full details of how to make a complaint and what should happen when this complaint was received. The policy also detailed the process involved with recording and investigating complaints. Guests advised that a copy of the complaints policy was available in each bedroom and that the policy was easy to follow. However guests spoken with advised that they had never had occasion to complain about anything. Guests said that the manager and staff spoke with them each day to ask if they had any concerns and they were also provided with a questionnaire at the end of each visit to enable them to say what they thought about the staff and services within the home. Ruskin Lodge F53 F03 S22408 Ruskin Lodge V235916 230605 Stage 4.doc Version 1.40 Page 13 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19.23.25.26. The environment is safe and well maintained and guests reside in comfortable bedrooms in clean, pleasant, comfortable surroundings. EVIDENCE: A tour of the premises revealed that the environment was well maintained. The furnishings and fabrics in all rooms were of a good standard and the home presented as clean and hygienic at the time of the visit. Maintenance records were well managed and the manager advised that the maintenance person holds responsibility for the testing, recording and risk assessing of all the essential services within the home. Guests spoken with appeared very happy with their bedrooms and the communal space in the home and comments included “my room is perfect”, ”the rooms are clean, comfortable and safe”,” the furnishings and fabrics are so good and look at that view” ”we could not get any better than this, anywhere”. Comments about the communal space included” the atmosphere in the dining room is so good”,” it is a pleasure to dine in this room” ”this is better than most restaurants ”,”the lounges are wonderful”, “this lounge is so comfortable”, “what a beautiful home”.
Ruskin Lodge F53 F03 S22408 Ruskin Lodge V235916 230605 Stage 4.doc Version 1.40 Page 14 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27.30 Staff are recruited, supported and trained to meet the care needs of the guests of Ruskin Lodge. EVIDENCE: Staff spoken with said that staff turnover was low and that staff had worked together for quite some time and worked well as a team. They identified through discussion that they had received training in care practices and risk assessment and were competent to do their jobs. Observation of the staff carrying out their duties showed that staff were professional, sensitive and respectful to guests and the atmosphere in the home appeared to be one of mutual trust and rapport. Guests said that they were treated well by all staff and that all identified needs had been met. Comments included “the staff are wonderful”, ”nothing is too much trouble for them”, ”I don’t know how they manage to provide so much help”, ”they know what we want and make sure we get it”. The staff roster showed that staffing levels were adequate to meet the assessed need of the current guests of the home. However it was noted during the inspection that the cook had the extra responsibility of providing a meal for the day centre visitors who had joined the guests for lunch and as a consequence she had cooked for approximately forty people. It was apparent that the staff had to work extremely hard to clear tables, wash dishes and tidy the kitchen area. It would be recommended therefore that extra staff were provided in the kitchen area to clear up and stack dishes at the times when day centre visitors joined guests at mealtimes.
Ruskin Lodge F53 F03 S22408 Ruskin Lodge V235916 230605 Stage 4.doc Version 1.40 Page 15 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31.32. The home is managed by a person who is fit and competent to carry out the role. Staff and guests benefit from the ethos, leadership and management approach of the home. EVIDENCE: Staff spoken with advised that the management approach of the home was open and transparent and that staff felt included in the running of the home and valued for their contribution. Guests revealed that they felt a part of the home and were consulted with on a daily basis about their thoughts and views. Discussion with the home manager identified that she has settled into her role and has full awareness of her responsibilities and carries them out to a high standard. Policies, procedures, records and other documentation further evidenced that the manager is fit and competent to carry out her role. Ruskin Lodge F53 F03 S22408 Ruskin Lodge V235916 230605 Stage 4.doc Version 1.40 Page 16 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 4 8 x 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 4
COMPLAINTS AND PROTECTION 4 x x x x x x x STAFFING Standard No Score 27 3 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x 4 4 x x x x x x Ruskin Lodge F53 F03 S22408 Ruskin Lodge V235916 230605 Stage 4.doc Version 1.40 Page 17 no 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 Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard 12 27 Good Practice Recommendations It is recommended that the regsieterd person introduces an activites prograame to ensure daily activites and interests are in place. it is recommened that the registered person provides extra kitchen staff when the number of meals prepared at one sitting is over 25 Ruskin Lodge F53 F03 S22408 Ruskin Lodge V235916 230605 Stage 4.doc Version 1.40 Page 18 Commission for Social Care Inspection Burlington House Crosby Road North Waterloo Liverpool L22 0LG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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