CARE HOMES FOR OLDER PEOPLE
Rutland Manor 99-109 Heanor Road Ilkeston Derbyshire DE7 8TA Lead Inspector
Janet Morrow Unannounced Inspection 16th January 2006 10:30 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.V286074.R01.S.doc Version 5.1 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.V286074.R01.S.doc Version 5.1 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.V286074.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 13th July 2005 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-ordiator is employed at the home and health professionals such as General Practiitioner and chiropodist are accessed as required. Rutland Manor DS0000002162.V286074.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection visit was unannounced and took place over six hours. Care records were examined and some [policies and procedures were examined. Four members of staff, six of thirty-nine residents currently accommodated, four relatives and one visiting professional were spoken to. One visiting professional was contacted by telephone following the inspection visit. A partial tour of the premises was undertaken. What the service does well: What has improved since the last inspection?
Good progress had been made in meeting the requirements and recommendations issued at the last inspection in July2005. The home had continued its programme of refurbishment and re-decoration of bedrooms, and had registered two new en-suite bedrooms. New bedroom furniture had been provided, including adjustable beds. A new central heating system had been installed and this had eradicated the problem of excessive heat in one bedroom. Water safety systems were in place and temperatures at outlets tested were safe. There had been no staff shortages recently and agency staff were used for any shifts requiring cover. There was positive feedback about the new system of working that had been put in place, which entailed staff working with a small number of residents. Staff felt that this enabled them to know residents better and be able to meet individual needs more comprehensively. There had been additional information obtained to ensure that staff were fully aware of the Local Authority procedures in adult protection. There was better information on residents’ care records to ensure that all identified risks were acted upon appropriately. Staff supervision was taking place and the views of relatives were being sought to improve and maintain the quality of care in the home.
Rutland Manor DS0000002162.V286074.R01.S.doc Version 5.1 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Rutland Manor DS0000002162.V286074.R01.S.doc Version 5.1 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.V286074.R01.S.doc Version 5.1 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): 1, 2, 3 and 4 There was sufficient information available for prospective residents to make an informed choice about the home and there was sufficient admission information to establish that the home was able to meet residents’ needs. EVIDENCE: The home had developed a comprehensive statement of purpose and residents’ guide that provided useful information for prospective residents. However, there were two items detailed in Schedule 1 of the Care Homes Regulations 2001 that were missing, namely the age range of residents to be accommodated and details of any therapeutic techniques employed in the home. A sample terms and conditions of residence was examined. This detailed the cost of nursing care, personal care and accommodation and what was not included in the fees. Four residents care records were examined and all had an assessment in place, including information from the assessment and care management process, where appropriate. This information included risk assessments for falls and pressure sores as well as a general moving and handling assessment. The
Rutland Manor DS0000002162.V286074.R01.S.doc Version 5.1 Page 9 information available established that the home was able to meet residents’ needs and relatives and a visiting professional interviewed also confirmed this. Staff interviewed stated that they had undertaken some training in dementia that enabled them to meet needs but additional input from specialist trainers on specific models of care would be beneficial to the home. Rutland Manor DS0000002162.V286074.R01.S.doc Version 5.1 Page 10 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 and 9 Health care needs were generally met but some inconsistencies in medication administration procedures had the potential to put residents at risk. EVIDENCE: Care planning and assessment information was available in the four residents’ care files examined. Risks identified in assessment documentation were followed through into interventions to minimise the risks. For example, in one file examined, there was a tissue viability risk assessment that indicated a high risk of pressure sores and a care plan was in place to deal with the risk. A visiting professional also confirmed that advice was sought appropriately in relation to pressure sore care. Nutritional assessments and assessments for risk of falls were available on the four files examined and corresponding care plans were available to deal with any identified need. The home consulted with an outside agency regarding falls prevention and used hip protectors for those residents identified as requiring them. Relatives interviewed were satisfied with the care with one stating residents were ‘well looked after’. Written feedback received at the home from a relative stated that the ‘quality of the nursing care was outstanding’. Rutland Manor DS0000002162.V286074.R01.S.doc Version 5.1 Page 11 Medication administration procedures were examined and the medication administration record (MAR) charts of four residents were seen. On all four MAR charts, there was at least one signature missing where a medicine had been given. On one chart it was unclear from the written instructions and the dosage system whether or not a medicine had been administered and on hand written MAR charts there was only one signature, which indicated that the information had not been checked. One medicine supply had run out, as it had not been ordered in time. The deputy manager stated that the home did not administer homely remedies. The records of controlled drugs were checked and were found to be in order with the stock corresponding with the written record. New medicine disposal arrangements had been organised to comply with changes in legislation. The medication refrigerator temperatures were recorded and were within safe limits. A copy of the Royal Pharmaceutical Society Guidelines was available. Rutland Manor DS0000002162.V286074.R01.S.doc Version 5.1 Page 12 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): 13 and 14 Arrangements for contact with families and access to personal information ensured that residents were helped to maintain control over their lives. EVIDENCE: Those relatives spoken with confirmed that they were made to feel welcome at any time and were able to visit when they wished. Information in the statement of purpose stated that there were no restrictions on visiting. On all four care files examined there was an assessment for advocacy needs and letters to relatives that indicated care needs had been discussed and that care records could be accessed. The manager was aware of who to contact for an advocacy service. Rutland Manor DS0000002162.V286074.R01.S.doc Version 5.1 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. EVIDENCE: The complaints procedure was examined and this showed that complaints would be dealt with in twenty-eight days. However, the title of the Commission for Social Care Inspection was incorrect in the procedure. The complaints record was seen and showed that there had been no complaints since the last inspection. There had also been no complaints received at the office of Commission for Social Care Inspection since the last inspection in July 2005. Those residents who wished to vote were enabled to do so by registering for a postal vote or being taken to a polling station. Adult protection procedures were in place and staff had attended training in dealing with abuse. This included two senior carers who had been trained to present the course to other staff. 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 July 2005. Rutland Manor DS0000002162.V286074.R01.S.doc Version 5.1 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 and 25 The building had undergone a process of refurbishment and the plans for further improvements will ensure the ongoing comfort and safety of residents. EVIDENCE: The home was generally clean and tidy and although refurbishment was continuing, there were some areas that needed attention. For example, most bedroom doors ion the ground floor where scratched and one bedroom seen had wallpaper peeling off the wall. A new staff room was to be developed and a new central heating system had been installed. A system was in place to ensure water safety that included checks on water tanks and boiler temperatures. A certificate dated November 2005 showed that checks had taken place for risk of Legionella and that this was satisfactory. A random sample of three water outlets showed that water was at a safe temperature. Rutland Manor DS0000002162.V286074.R01.S.doc Version 5.1 Page 15 Rutland Manor DS0000002162.V286074.R01.S.doc Version 5.1 Page 16 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 and 28 There were sufficient qualified staff deployed, which ensured that residents’ care needs were met. EVIDENCE: The staff rotas for 9th – 22nd January 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 five on the afternoon shift. Those staff interviewed confirmed that there were sufficient staff to meet residents’ needs and the manager stated that there had been no issues regarding staffing over recent months and that the staff group had been stable. Agency staff were used for any difficulties with covering shifts. The home was committed to National Vocational Qualifications (NVQ) training and thirteen of twenty-one care staff had achieved an NVQ level 2 or were undertaking it. This ensured that the home met the standard of having 50 of care staff qualified to NVQ level 2. Rutland Manor DS0000002162.V286074.R01.S.doc Version 5.1 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): 33, 36, 37 and 38 The home was well managed and health and safety needs were addressed which ensured that residents’ interests were safeguarded. EVIDENCE: The home had a written policy on quality assurance and had improved its procedures to include more views of the home. These included views from relatives and staff and also comments from residents. The proprietor stated that issues raised by residents had been addressed immediately where possible, such as having condiments on the tables at meals. Most of the comments from staff and relatives expressed satisfaction with the home, with one relative commenting that they were ‘very happy with the care and treatment given’. There were no comments from visiting professionals. Staff supervision was taking place on a three monthly basis and was recorded. However, not all staff interviewed were convinced of its benefits and did not
Rutland Manor DS0000002162.V286074.R01.S.doc Version 5.1 Page 18 know the difference between supervision and appraisal. It did not include career development or philosophy of care in the home Some records required by Schedules 1 and 2 of the Care Homes Regulations 2001 had information missing, such as information from the statement of purpose and recruitment information from staff files. Water safety records were examined and these were up to date. A notice on the wall showed that health and safety training was due to take place. Staff interviewed confirmed that training in health and safety issues such as first aid, fire safety and food hygiene took place. Rutland Manor DS0000002162.V286074.R01.S.doc Version 5.1 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 2 3 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 2 X X X X X 3 X STAFFING Standard No Score 27 3 28 3 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X X 3 2 3 Rutland Manor DS0000002162.V286074.R01.S.doc Version 5.1 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 OP29 Regulation 19 (1) (b) Requirement There must be evidence that information and documents specified in Schedule 2 of the Care Homes Regulations 2001 have been obtained on all staff employed at the home. This requirement was not assessed on this occasion. Previous timescale of 1.9.05 outstanding. The statement of purpose must contain a statement as to the matters listed in Schedule 1 of the Care Homes Regulations 2001. There must be arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. The premises must be of sound construction and kept in a good state of repair externally and internally. The home must maintain the
DS0000002162.V286074.R01.S.doc Timescale for action 01/04/06 2. OP1 4 (1) (c) 01/05/06 3. OP9 13 (2) 01/05/06 4. OP19 23 (2) (b) 01/05/06 5. OP37 17 (2) & 01/05/06
Version 5.1 Page 21 Rutland Manor 4(1) (c) records specified in Schedule 1-4 of the Care Homes Regulations 2001. 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 OP29 Good Practice Recommendations Décor should be improved as identified in the report There should be a thorough written explanation of gaps in employment and in care work. This was an outstanding recommendation and was not assessed on this occasion. Fixed screening around bed and sink should be provided in shared rooms. The statement of purpose should contain the age range of residents to be accommodated and details of any therapeutic techniques employed in the home. Specialist training in models of dementia care should be considered to enable the home to improve its response to individual needs. 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 not run out. The correct title of the Commission for Social Care Inspection should be detailed in the complaints procedure. The views of visiting professionals should be sought to assist in quality assurance.
DS0000002162.V286074.R01.S.doc Version 5.1 Page 22 3. 4. OP24 OP1 5. OP4 6. 7. 8. 9. 10. OP9 OP9 OP9 OP16 OP33 Rutland Manor 11. OP36 Staff supervision should take place 6 times per year and cover care practice, career development and philosophy of care in the home. The information in Schedules 1, 2 and 4 should be maintained. 12. OP37 Rutland Manor DS0000002162.V286074.R01.S.doc Version 5.1 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
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