Inspection on 10/07/06 for Rutland Manor

This inspection was carried out on 10th July 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

Rutland Manor 02/06/08

Rutland Manor 11/06/07

Rutland Manor 16/01/06

Rutland Manor 02/11/04

Rutland Manor 27/05/04

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

CARE HOMES FOR OLDER PEOPLE Rutland Manor 99-109 Heanor Road Ilkeston Derbyshire DE7 8TA Lead Inspector Janet Morrow Unannounced Inspection 10th July 2006 09:40 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Rutland Manor DS0000002162.V301430.R02.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Rutland Manor DS0000002162.V301430.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Rutland Manor Address 99-109 Heanor Road Ilkeston Derbyshire DE7 8TA 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) 0115 944 0322 01159 321793 Rutland Manor Limited Ann Kathleen Martin Care Home 41 Category(ies) of Dementia - over 65 years of age (41) registration, with number of places Rutland Manor DS0000002162.V301430.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 16th January 2006 Brief Description of the Service: Rutland Manor is situated on the outskirts of Ilkeston. The building was previously a hospital. The accommodation is arranged on two floors with lounges and communal areas all being on the ground floor. Ongoing refurbishment is being undertaken to upgrade the accommodation. The home is registered as a care home with nursing for residents with dementia and can accommodate up to 41 residents. An activities co-ordinator is employed at the home and health professionals such as General Practitioner and chiropodist are accessed as required. Rutland Manor DS0000002162.V301430.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection visit was unannounced and took place over 6.25 hours. Care records, staff records and some policies and procedures were examined. Two members of staff, eight of thirty-seven residents currently accommodated and five relatives were spoken with. A partial tour of the premises was undertaken. Quality assurance surveys undertaken by the home were examined. Written information supplied by the home informed the inspection process. A recent adult protection enquiry was discussed with the manager. The outcome of this was not known at the time of the inspection. What the service does well: What has improved since the last inspection? What they could do better: Rutland Manor DS0000002162.V301430.R02.S.doc Version 5.2 Page 6 Medication procedures should be improved to ensure that medication administration record (MAR) charts are completed accurately and the risk of errors is minimised. This was raised as an issue at the last inspection in January 2006 and an immediate requirement notice was therefore issued to ensure that this was rectified as a matter of urgency. Some aspects of care planning should be improved to ensure that risk assessments were properly addressed and there was sufficient attention given to prevention of falls, moving and handling arrangements and pressure sore prevention. The refurbishment in the home needs to continue to maintain good environmental standards, and should include re-decoration where identified and the provision of fixed screening in shared rooms. 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. Rutland Manor DS0000002162.V301430.R02.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Rutland Manor DS0000002162.V301430.R02.S.doc Version 5.2 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 the following standard(s): 3 and 4 There was sufficient admission information to establish that the home was able to meet residents’ needs. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. EVIDENCE: Four residents’ care records were examined and all had an assessment in place. This information included risk assessments for falls and pressure sores as well as a general moving and handling assessment. The information available established that the home was able to meet residents’ needs and relatives interviewed also confirmed that needs were well met. The manager stated that specialist training in dementia had been organised for September 2006 to enhance the care provided. Rutland Manor DS0000002162.V301430.R02.S.doc Version 5.2 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 the following standard(s): 7, 8, 9, and 10 Health care needs were generally met but some inconsistencies in medication administration procedures and action taken in relation to risk assessments had the potential to put residents at risk. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. EVIDENCE: Care planning and assessment information was available in the four residents’ care files examined. However, risks identified in assessment documentation were not always followed through into interventions to minimise the risks. For example, in three files examined, there was a tissue viability risk assessment that indicated a high risk of pressure sores but there was no care plan in place on how to deal with the risk. There were also no specific assessments for risk of falls on any of the files examined, although the last inspection in January 2006 had noted that these were available. Moving and handling arrangements were discussed with staff and assessments were in place on all the files seen. However, the recent adult protection incident involving an unexplained injury had noted a discrepancy between what was recorded in the moving and handling risk assessment and what staff said actually happened. Rutland Manor DS0000002162.V301430.R02.S.doc Version 5.2 Page 10 Care planning information tended to be brief and several areas of need were noted as needing ‘observation’ and ‘encouragement’ but were not specific on how this should be carried out. The medication administration record (MAR) charts of twenty-three residents were examined to check the accuracy of the recording. The majority had at least one missing signature where medication had been administered. Four residents’ MAR charts were then examined in more detail and the following was found: • One chart had three missing signatures where a medicine had been given and one medicine that had not been administered had been signed as given; • One chart had one signature missing where the medicine had been given and there were three handwritten entries had not been signed and dated by two people. On the same chart there was also one drug that had not been supplied on admission so the resident had not received it since 17th June 2006. The deputy manager stated that this had been chased up with the General Practitioner but there had been a delay as the resident was being assigned to a new practice; • One chart had one missing signature where a medicine had been administered and there were inconsistencies in the use of codes for medicines that were prescribed as ‘as required’, which meant that it was unclear whether or not the medicine had been administered. • One chart corresponded accurately with the medication dispensing system. There were loose tablets observed in a container in the medicine trolley. The deputy manager stated that these were due to be destroyed as they had been refused at the morning medicine round. However, the MAR chart showed that they had been signed as administered. The manager stated that Temazepam was stored and administered under controlled conditions and the records of Temazepam corresponded with the stock held. There were no controlled drugs currently in stock. The medication refrigerator temperatures were recorded and were within safe limits. A copy of the Royal Pharmaceutical Society Guidelines was available. Observation during the visit showed that privacy and dignity was upheld and residents were observed to have warm relationships with staff. Relatives interviewed confirmed this and described the staff as ‘caring’ and quality assurance surveys from visiting professionals also confirmed this, one of which described the staff as ‘very approachable’. Rutland Manor DS0000002162.V301430.R02.S.doc Version 5.2 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 the following standard(s): 12, 13, 14 and 15 Meals, activities and contact with the community were well organised and enhanced residents’ daily lives. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. EVIDENCE: The home had an activities co-ordinator who organised a range of events to entertain and motivate residents. Both residents and their relatives interviewed confirmed that that the routines of the home were flexible and it was observed that residents’ had the choice of staying in their own rooms, or participating in activities. Detailed information was maintained on residents’ past history and likes and dislikes, which were incorporated into their social care plan. Those relatives spoken with confirmed that they were made to feel welcome at any time and were able to visit when they wished. Some relatives had meals at the home and praised the food. Those residents spoken with also said they enjoyed their meals. The written information supplied by the home included sample menus that showed meals were wholesome and nutritious. The serving of the lunchtime meal was observed and demonstrated that individual preferences were taken into account. The dining area was bright and cheerful. The manager was aware of who to contact for an advocacy service and stated that no one in the home had an advocate at the present time. Rutland Manor DS0000002162.V301430.R02.S.doc Version 5.2 Page 12 Rutland Manor DS0000002162.V301430.R02.S.doc Version 5.2 Page 13 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 the following standard(s): 16 and 18 Systems were in place to ensure that complaints and adult protection issues were responded to appropriately, which ensured that residents were protected and their concerns handled objectively. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. EVIDENCE: The complaints procedure was examined and this showed that complaints would be dealt with in twenty-eight days. The procedure had been amended to ensure that the title and contact details of the Commission for Social Care Inspection were correct. The written information supplied by the home and the manager both stated that there had been no complaints since the last inspection in January 2006. There had also been no complaints received at the office of the Commission for Social Care Inspection since the last inspection in January 2006. Adult protection procedures were in place and the written information supplied by the home stated that staff had attended training in dealing with abuse in July 2005 and a further course was to be attended in July 2006. The home also had the full documentation of Derby and Derbyshire Local Authority Social Services procedures. The manager stated that there had been no allegations of abuse since the last inspection in January 2005. However, a recent unexplained injury was being investigated via adult protection procedures and the investigation was not complete at the time of the inspection visit. Rutland Manor DS0000002162.V301430.R02.S.doc Version 5.2 Page 14 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 the following standard(s): 19, 20 and 26 The building had undergone a process of refurbishment and the plans for further improvements will ensure the ongoing comfort and safety of residents. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. EVIDENCE: The home was generally clean, tidy and odour free and refurbishment was taking place that meant that there were some areas, for example corridors that were not yet decorated. A new staff room was being built. The written information supplied by the home stated that some refurbishment of bedrooms had taken place with decoration, new carpets and furniture being provided. A relative spoken with also confirmed this. A new carpet had been fitted in the lounges and a staircase and hallway had been re-decorated. The laundry was viewed and was neat and tidy and all equipment was in working order. Communal areas were spacious and the garden area had been improved to provide outside seating and a patio area. Rutland Manor DS0000002162.V301430.R02.S.doc Version 5.2 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 There were sufficient qualified staff deployed, which ensured that residents’ care needs were met. Recruitment procedures were robust, which ensured that residents were protected. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. EVIDENCE: The staff rotas for 26th June – 2nd July 2006 were examined. This showed that there were two nurses on duty on the daytime shifts and one nurse at night. There were also six care staff on the morning shift and six on the afternoon shift. The manager and proprietor stated that there were no current issues with staffing and that there was a stable group of staff employed. The home was committed to National Vocational Qualifications (NVQ) training and the written information supplied by the home stated that fourteen of twenty-one care staff had achieved an NVQ level 2, which was approximately 70 of the care staff. This ensured that the standard of having 50 of care staff qualified to NVQ level 2 was exceeded and the home is therefore commended for its commitment to NVQ training. The written information supplied by the home stated that mandatory health and safety training took place and staff interviewed confirmed that there were regular updates on moving and handling. This was confirmed in staff files that held certificates for moving and handling issued in June 2006. It also stated that additional training on subjects relevant to the home such as dementia, diabetes and continence also took place. A specialist course had been booked Rutland Manor DS0000002162.V301430.R02.S.doc Version 5.2 Page 16 for September 2006 to study a particular method of working with people with dementia. Staff files showed that induction training for new starters took place, with staff signing to say they had completed the programme. Two staff files were examined and showed evidence of good recruitment processes. All documentation required by Schedule 2 of the Care Homes Regulations 2001 was in place, including a Criminal Record Bureau check, evidence of identity and qualification and two written references. The application form also showed gaps in employment and reasons for gaps. Rutland Manor DS0000002162.V301430.R02.S.doc Version 5.2 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 37 and 38 The home was well managed and health and safety needs were addressed which ensured that residents’ interests were safeguarded. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. EVIDENCE: The manager had recently completed the Registered Managers Award and had several years experience in caring for older people. Three residents’ financial records were examined and were found to be completed accurately. Cash was stored securely. Some records required by Schedule 3 of the Care Homes Regulations 2001 had information missing such as health information from residents’ care files, as detailed earlier in the report. A valid insurance certificate and registration certificate were on display. Staff training records and the written information supplied by the home indicated that training had been undertaken in mandatory health and safety subjects such as first aid, moving and handling, food hygiene and fire safety. Rutland Manor DS0000002162.V301430.R02.S.doc Version 5.2 Page 18 The written information also stated that regular maintenance of equipment took place that included fire equipment in October 2005, water safety in November 2005, emergency lighting in June 2006 and hoists in June 2006. Quality assurance systems were in place and recent feedback in June 2006 from relatives and visiting professionals was positive with comments such as ‘good standard of care’, ‘staff always knowledgeable’ and the home was ‘a credit to its owner’. Rutland Manor DS0000002162.V301430.R02.S.doc Version 5.2 Page 19 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 X X 3 3 X 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 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 3 X X X X X 3 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X 2 3 Rutland Manor DS0000002162.V301430.R02.S.doc Version 5.2 Page 20 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 OP1 Regulation 4 (1) (c) Requirement The statement of purpose must contain a statement as to the matters listed in Schedule 1 of the Care Homes Regulations 2001. This requirement was not assessed on this occasion. Time scale of 01/05/06 extended. A written plan must be prepared as to how residents’ needs in respect of health and welfare are to be met. The care home must be conducted so as to make proper provision for the health and welfare of residents. There must be arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. Previous timescale of 01/05/06 not met. Now immediate. The premises must be of sound construction and kept in a good state of repair externally and internally. DS0000002162.V301430.R02.S.doc Timescale for action 01/09/06 2. OP7 15 (1) 01/09/06 3. OP8 12 (1) (a) 01/09/06 4. OP9 13 (2) 12/07/06 5. OP19 23 (2) (b) 01/09/06 Rutland Manor Version 5.2 Page 21 6. OP37 17 (2) & 4(1) (c) This is a previous requirement that has not been fully addressed. Timescale extended. The home must maintain the records specified in Schedule 1-4 of the Care Homes Regulations 2001. Previous timescale of 01/05/06 not met. Timescale extended. 01/09/06 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. 2. Refer to Standard OP19 OP24 Good Practice Recommendations Décor should be improved as identified in the report, in corridors and areas where building work is complete. Fixed screening around bed and sink should be provided in shared rooms. This is a previous recommendation and was not assessed on this occasion. The statement of purpose should contain the age range of residents to be accommodated and details of any therapeutic techniques employed in the home. This is a previous recommendation and was not assessed on this occasion. All care plans should include a risk assessment for falls and, where necessary, there should be details on how falls are to be prevented. Care plans should contain sufficient detail on how to provide the care required and all identified needs should have a care plan. The instructions on moving and handling assessments should be carried out as detailed. All medicine administered should be signed for on the medication administration record (MAR) chart. Hand written MAR charts should be signed and dated by two people. Medication supplies should be obtained promptly following admission. DS0000002162.V301430.R02.S.doc Version 5.2 Page 22 3. OP1 4. 5. 6. 7. 8. 9. OP7 OP7 OP8 OP9 OP9 OP9 Rutland Manor 10. OP36 11. OP37 Staff supervision should take place 6 times per year and cover care practice, career development and philosophy of care in the home. This is a previous recommendation and was not assessed on this occasion. The information in Schedules 1, 3 and 4 should be maintained. This is a previous recommendation and has not yet been fully addressed. Rutland Manor DS0000002162.V301430.R02.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT 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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