Inspection on 02/06/08 for Rutland Manor

This inspection was carried out on 2nd June 2008.

CSCI found this care home to be providing an Good 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

Rutland Manor 11/06/07

Rutland Manor 10/07/06

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 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Rutland Manor 99-109 Heanor Road Ilkeston Derbyshire DE7 8TA Lead Inspector Janet Morrow Unannounced Inspection 2nd and 3rd June 2008 09:35 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.V365769.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. 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.V365769.R01.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 0115 932 1793 rutlandmanor@fsmail.net Rutland Manor Limited Manager post vacant Care Home 41 Category(ies) of Dementia (41), Mental disorder, excluding registration, with number learning disability or dementia (1) of places Rutland Manor DS0000002162.V365769.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered provider may provide the following category of service only: Care Home with nursing - Code N To service users of the following gender: Either Whose primary care needs on admission to the home fall within the following categories: Dementia - Code DE The maximum number of service users who can be accommodated is: 41 One service user named in the letter received by the service dated 2 October 2007 to remain at the home under the category Mental Disorder - Code MD 11th June 2007 2. 3. Date of last inspection 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. Information provided by the service in June 2008 stated that the fees were in the range of £584 - £650 per week. Details of previous inspection reports can be found on the Commission for Social Care Inspection’s website: www.csci.org.uk and are located in the entrance of the home. Rutland Manor DS0000002162.V365769.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This inspection visit was unannounced and took place over two days for a total of 15.5 hours. Two hours were spent observing the care given to people in the conservatory area. The care of five people was looked at in depth when comparisons with the observations were made with the home’s records and the knowledge of the care staff. Care records and staff records and a sample of policies and procedures were examined. Seven members of staff, nine of thirty-six people currently accommodated, one visiting professional and six relatives were spoken with. One visiting professional was contacted by telephone following the inspection visit. A partial tour of the premises was undertaken. Quality assurance surveys undertaken by the home were examined. Eight surveys from people living at the home were returned to the Commission for Social Care Inspection prior to the visit but limited information was available on these due to their communication needs. Five staff surveys were also received and three relatives’ surveys were received. Written information supplied by the home informed the inspection process. The manager and the responsible individual were spoken with and safeguarding issues were discussed with them following a recent conviction of a former member of staff of abusive practice. What the service does well: Rutland Manor has a number of staff who have worked at the home for several years, which helps to provide a stable and caring environment. All the people who were able to express their opinion and relatives spoken to were pleased with the service provided. One person said she ‘loved coming here’. The home responded well to allegations of abuse and followed safeguarding procedures properly to ensure investigations by the relevant agency took place. Rutland Manor DS0000002162.V365769.R01.S.doc Version 5.2 Page 6 Peoples’ individual interests and social history were well documented in care plans and there was encouragement to take part in a range of activities according to individual ability and interest. The observation showed that the majority of communication with people living in the home demonstrated an understanding of individual needs and that respect and dignity was maintained and a range of activities were on offer. Staff gave positive feedback about the management arrangements and stated that they worked together well as a team and had the right support and guidance to enable them to do their jobs. Comments received during the inspection visit and on surveys were positive, as follows: ‘attentive towards their service users at all times’ ‘staff treat her with dignity and friendliness’ ‘a caring family environment’ ‘relaxed’ ‘one big family’ ‘definitely welcoming’ ‘staff need great patience to do the job as well as they do’ What has improved since the last inspection? What they could do better: Staff recruitment information must always account for gaps in employment and a Protection of Vulnerable Adults (POVA) First check must be in place prior to staff commencing work to ensure that legal requirements are met. There must always be a care plan in place where there is an identified risk to ensure that staff know what to do and to ensure care needs are met. Where bed rails are being used, there must always be an assessment in place. Rutland Manor DS0000002162.V365769.R01.S.doc Version 5.2 Page 7 Consideration should be given to making arrangements for more people to go outdoors and have visits out of the building. All staff should received training on the Mental Capacity Act 2005 to ensure they are familiar with it and its implications for care services. The downstairs bathroom needs a curtain or similar to ensure privacy. All staff must receive training in infection control as this is a mandatory health and safety area and is necessary to ensure staff know how to prevent the spread infection and to meet legal requirements. Fire safety training must also be updated for all staff to ensure they are competent and know what to do in an emergency. The home should utilise Department of Health guidelines ‘Essential Steps’ when planning how to manage infection control. 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. The summary of this inspection report can be made available in other formats on request. Rutland Manor DS0000002162.V365769.R01.S.doc Version 5.2 Page 8 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.V365769.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There was sufficient admission information to establish that the home was able to meet peoples’ needs. EVIDENCE: Five peoples’ care records were examined and all had an admission assessment in place, and information from external professionals, where applicable. This information included risk assessments for nutrition and pressure sores as well as a general moving and handling assessment, plus a detailed social history and individual likes and dislikes. The home had also Rutland Manor DS0000002162.V365769.R01.S.doc Version 5.2 Page 10 started to use a falls risk assessment for those people at risk of falling, as recommended at the previous inspection in June 2007. The information available established that the home was able to meet peoples’ needs and relatives interviewed also confirmed that needs were well met. The observation showed that needs were addressed on an individual basis. The three relatives’ surveys received responded that needs were ‘always’ met and those relatives spoken with during the inspection visit also confirmed this. Written comments seen from a relative in an internal quality assurance survey stated that the care was ‘excellent’ and that people were ‘well looked after’. and a visiting professional spoken with stated that the home was ‘meeting needs’. Rutland Manor DS0000002162.V365769.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 and 11 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Health and personal care needs were met and the care of people living in the home was planned and given in a way that respected individuality. EVIDENCE: Care planning and assessment information was available in the five peoples’ care files examined. Risks identified in assessment documentation were followed through into interventions to minimise the risks in four of the five files examined. For example, where a tissue viability risk assessment indicated a high risk of pressure sores, there was a care plan in place on how to deal with the risk and where a nutritional risk was indicated, there was also a care plan to address the risk. However, one file did not have a specific care plan for pressure sores where a risk was indicated. Rutland Manor DS0000002162.V365769.R01.S.doc Version 5.2 Page 12 Where a risk of falls was identified on one file, an assessment tool had been used and appropriate action detailed on how to deal with the risk. There were instructions on four of the records that detailed how mobility issues were to be addressed. However, one file did not have a specific care plan for mobility although the moving and handling assessment stated that supervision was required and this was observed to occur for the person concerned during the inspection visit. Another did not have a risk assessment for use of bedrails, although they were in place. There were specific entries in all the care plans regarding the assistance required in relation to dementia. These emphasised the need to take account of individual preferences and ensure privacy and dignity. Family histories were being compiled for all people to ensure that individual likes and dislikes, important events and people were incorporated into the daily lives of people at the home. Apart from the omissions noted, care planning information was generally thorough and gave sufficient information to know how care was to be carried out. There was limited information on surveys received from people living at the home but where a response was available, three surveys said that they ‘always’ received the care, one said they ‘usually’ did and two said they ‘sometimes’ did. Two of the three relatives’ surveys responded that the home ‘always’ provided the care they expected and one responded that they ‘usually’ did. All five staff surveys received responded that they ‘always’ received up to date information about individual needs. One stated that care plans were ‘very informative’ and two commented that information was passed on at each shift handover. One survey stated that ‘every resident is spoken about during handover. We are well informed’. A visiting professional also stated that staff had a ‘good working knowledge’ of care issues. The observation carried out looked specifically for indications of peoples’ wellbeing and/or distress and type of staff interaction. During the period of observation, there was little evidence of people being distressed and staff were proactive in engaging with people in a positive manner, such as playing games and having a conversation. Requests for assistance were responded to promptly. One person who was crying for a short period was comforted appropriately by staff and a specific need handled sensitively. There was a lot of activity taking place during the observation period and no staff interactions were negative, with care and assistance being provided in a sensitive manner. Privacy and dignity was upheld and people living at the home were observed to have warm relationships with staff. Relatives interviewed confirmed this and described the staff as ‘caring’, ‘very nice’ and ‘very good’. An internal survey Rutland Manor DS0000002162.V365769.R01.S.doc Version 5.2 Page 13 from a visiting professional described staff as ‘approachable and friendly’ and the care as ‘excellent’. Seven peoples’ medication administration record (MAR) charts were examined to check the accuracy of the recording. This showed that records were accurate, with signatures in place for medicines dispensed, with the exception of one medicine for one person on one date. Two people were signing handwritten medication administration record (MAR) charts to ensure they were accurate and the amount of medication received into the home was being recorded consistently on all charts. Five peoples’ MAR charts were then examined in more detail and were completed accurately. The records of controlled drugs were examined and accurately corresponded with the medicines held. Temazepam was stored under controlled conditions. Secure storage facilities were available. A general check on medicine stocks was carried out and found to be satisfactory with no medicines being past their expiry date. The temperature of the storage room was discussed with the manager and consideration was being given to the installation of an air conditioning unit to ensure the temperature remained at a safe level. A copy of a quote for a unit was seen. The manager was undertaking regular monitoring of recording on MAR charts and taking action if any discrepancies were found. This had helped maintain improvements in medication administration recording since the last inspection in June 2007. End of life care and the use of the ‘Liverpool Care Pathway’ was discussed with the manager. Although there was no-one currently receiving care using the Liverpool Care Pathway, the manager was able to give an example of where this had been used successfully. There was information available and the manager was proactive in promoting its use and saw end of life care as her speciality, contributing to teaching in this area at the local university. Rutland Manor DS0000002162.V365769.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Activities, community contact and meals were well managed, which enhanced peoples’ quality of life. EVIDENCE: The home had an activities co-ordinator who organised a range of events to entertain and motivate. People living in the home and their relatives spoken with confirmed that that the routines of the home were flexible and it was observed that people had the choice of whether or not to participate in activities. Detailed information was maintained on individuals’ past history and likes and dislikes, which were incorporated into their social care plan. The observation showed that a range of recreational options were available to people; for example, staff were observed chatting with individuals, looking at newspapers, throwing balloons and playing dominoes with them. Some people Rutland Manor DS0000002162.V365769.R01.S.doc Version 5.2 Page 15 were looking at books and magazines, others playing musical instruments and they were also being assisted to see the hairdresser. Three staff surveys received commented that the home could improve by arranging more time for people to be out of doors either on trips or within the garden area. Staff spoken with were knowledgeable about individuals’ routines and were observed to be aware of changes in behaviour. For example, one person was asleep for the majority of the observation period and staff were heard commenting that this was unusual and adjusted their meal time accordingly. There was a general tendency for staff to ensure that some activity was occurring for the whole of the observation period and this gave the impression that this was for the benefit of the observation rather than something that occurred naturally. The written information supplied by the home stated that religious ministers from the local area visited the home on a regular basis. All relatives spoken with during the visit confirmed that they were made to feel welcome at any time and were able to visit when they wished. The manager was aware of who to contact for an advocacy service and stated that no one in the home currently had an advocate. The written information supplied by the home stated that advocacy services had been contacted for support and the manager was aware of the Mental Capacity Act 2005 and its implications for decision making with people who have impaired abilities. However, staff had not yet received any training on this although it was planned to arrange this over the coming months. Those people spoken with also said they enjoyed their meals and stated that they were offered alternatives if they did not like what was on offer. Staff spoken with were aware of individual likes and dislikes and were able to discuss various strategies to ensure that people ate a balanced diet. Snacks were provided throughout the day. One person said that they liked the food because it was ‘ordinary, no fancy stuff’ and was what she used to eat at home. Six of the surveys received from people living in the home provided a response in relation to meals. Four responded that they ‘always’ liked them, one responded that they ‘usually’ did and one responded that they ‘sometimes’ did. Several relatives visited regularly at meal times and all stated that they thought the food provided was ‘good’. 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 mealtime was unhurried, with appropriate assistance being given to those people who needed help with eating. Rutland Manor DS0000002162.V365769.R01.S.doc Version 5.2 Page 16 The kitchen was clean and tidy and food stocks were good. However, there was limited knowledge about alternative protein sources for people opting for a vegetarian diet and the options provided tended to be cheese and eggs. Rutland Manor DS0000002162.V365769.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Systems were in place to ensure that complaints and safeguarding issues were responded to appropriately, which ensured that people were protected and their concerns handled objectively. EVIDENCE: The complaints procedure was examined and this showed that complaints would be dealt with in twenty-eight days. It was on display in the entrance of the home. The written information supplied by the home stated that there had been one complaint received at the home since the last inspection in June 2007. The record of this was examined and showed that it had been responded to appropriately and that the complainant was satisfied with the outcome. There had been no complaints received at the office of the Commission for Social Care Inspection since the last inspection in June 2007. Five of the eight surveys from people living in the home had provided a response when asked if they knew how to complain. Four responded that they knew how to make a complaint and one said they did not know. Rutland Manor DS0000002162.V365769.R01.S.doc Version 5.2 Page 18 Those relatives spoken with were aware of how to make a complaint and were confident of a courteous response. Two of the three relatives’ surveys received responded that they knew how to make a complaint and one stated ‘I cannot remember’. One survey said that ‘ In five and a half years, I have not had cause for complaint’ and another said ‘I have never had any concern about my mother’s care’. The home had a policy on safeguarding adults that stated any allegation of abuse must be reported to the appropriate authorities. This had occurred in the last allegation prior to the inspection visit in June 2007 and had resulted in a court hearing and subsequent conviction. The responsible individual and manager were both familiar with reporting procedures and how to refer to the Protection of Vulnerable Adults (POVA) list. The written information supplied by the home stated that safeguarding training had been undertaken in the last twelve months and all staff spoken with were aware of their responsibility to report any incidents. The recent conviction of a former member of staff was discussed at length with the manager and responsible individual. This discussion showed that recruitment, induction and training of staff covered safeguarding and there was ongoing supervision that addressed staff performance and competence. The responsible individual stated that the organisation had taken further steps in refining its policies to ensure no further incidents occurred within the home; for example, a new supervision policy had been devised, exit interviews were being implemented for any staff leaving, courses on dealing with challenging behaviour were being sourced, a questionnaire for staff on safeguarding had been devised and the senior nurse regularly asked questions related to safeguarding at the handover period to ensure staff had a good understanding of the issues. Accident audits were being maintained to see if any patterns of repeated accidents were occurring. The home had developed its policy on restraint and challenging behaviour and was taking a positive approach to dealing with any difficult incidents with physical restraint being a last resort. This was beneficial as it helped to avoid limiting peoples’ choices and movement and assisted with safeguarding both staff and people in the home. The written information supplied by the home stated that there had been no incidents where physical restraint had been used during the last twelve months. Rutland Manor DS0000002162.V365769.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 24 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The building was clean and tidy and provided safe, comfortable accommodation for people living in the home. EVIDENCE: A partial tour of the building showed that the home was clean, tidy and odour free at the time of this inspection visit. Rutland Manor DS0000002162.V365769.R01.S.doc Version 5.2 Page 20 The written information supplied by the home stated that some refurbishment had taken place since the last inspection visit in June 2007. This included: • New non slip cushion flooring in a corridor • A deep clean carpet cleaner and constant release air fresheners to maintain a fresh environment • Some bedrooms had been decorated • Re-decoration of the entrance area • Improved signage • New dining room furniture had been provided There was also decorating of the small lounge areas occurring during the inspection visit. There were sufficient toilets and bathrooms with relevant equipment to assist those people with physical difficulties, such as raised toilet sets, handrails, showers, a bath hoist and a Parker bath. However, two staff surveys commented that an improvement would be the provision of ‘more toilets’. One bathroom needed greater attention to privacy by the provision of a curtain around the bath and the manager stated that this was being pursued. Five bedrooms were viewed and were personalised with individual possessions. Plans for further developments included improving the garden area. The manager stated that this was being designed as a sensory garden by a local college and would provide a better outdoor space for people to use. The laundry was viewed and was neat and tidy and all equipment was in working order. Staff spoken with were aware of how to control the spread of infection and confirmed that there was always a plentiful supply of protective equipment such as gloves and aprons. However, although the written information supplied by the home stated that a policy on infection control was in place, it also stated that the Department of Health guidance ‘Essential Steps’ was not being used. Four surveys received from people living in the home responded that the home was ‘always’ fresh and clean and one responded that it ‘usually’ was. Rutland Manor DS0000002162.V365769.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Some inconsistencies in recruitment procedures and omissions in staff training had the potential to compromise the care and safety of people in the home. EVIDENCE: The staff rotas for the weeks 19th May – 15th June 2008 were examined and showed that there were sufficient staff on duty to meet peoples’ needs. There were two nurses on duty on the daytime shifts and one nurse at night and there were also six care staff on the morning and afternoon shifts and three on duty at night. This was consistent with the number of staff on duty at the time of the inspection visit. The manager stated that there were no issues currently with staffing and that agency staff were used infrequently. Four staff files were examined and generally showed evidence of good recruitment processes. Most of the documentation required by Schedule 2 of the Care Homes Regulations 2001 was in place, including a Criminal Record Bureau check, evidence of identity, evidence of license to practise for qualified staff and two written references. However, one file did not have a Protection of Rutland Manor DS0000002162.V365769.R01.S.doc Version 5.2 Page 22 Vulnerable Adults (POVA) First check in place prior to the member of staff commencing work in the home. The application forms on two files were not completed sufficiently to show reasons for gaps in employment, which was raised as an issue at the previous inspection in June 2007. The written information supplied by the home stated that 59 of staff had achieved a National Vocational Qualification at level 2. The home had therefore reached the target of 50 of staff with an NVQ2 although the actual number had decreased since June 2007. However, the home was committed to qualification training and staff and a visiting professional spoken with confirmed this. One staff survey received commented that through doing NVQ training, they were ‘getting full satisfaction knowing I am using my full potential for the needs of residents’. Staff training was ongoing and a training matrix had been developed to help identify quickly which staff needed updating. However, the written information supplied by the home stated that some mandatory training was out of date and this was also confirmed by one member of staff spoken with who stated that they had not completed infection control training or fire safety training. The written information supplied by the home stated that only five staff had received training in infection control and the training matrix showed that nine members of the care staff last completed fire training in May 2007, which meant it was now overdue. One staff survey commented that training in dementia, challenging behaviour and infection control were ‘all being implemented’ and that Liverpool care pathway training had been completed. Another stated that ‘appropriate training given with regards to disability and health problems e.g. catheter care’. All six staff surveys responded that they were kept up to date with new ways of working and five responded that they ‘always’ had the right support to meet different needs. Rutland Manor DS0000002162.V365769.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was well managed and health and safety needs were addressed which ensured that peoples’ interests were safeguarded. EVIDENCE: The manager was a trained nurse and had several years experience in caring for older people. The written information supplied by the home stated that she intended to commence the Registered Managers Award training in the next Rutland Manor DS0000002162.V365769.R01.S.doc Version 5.2 Page 24 twelve months. The manager had been appointed in November 2007 and had made an application to become registered with the Commission for Social Care Inspection, although this process was not yet complete. She was able to demonstrate in discussion that she was familiar with the needs of people with dementia. The responsible individual confirmed that a new management structure had been put place and there was now a deputy manager and a senior operational nurse, who were able to offer advice and guidance to staff in the absence of the manager. The manager won praise form another visiting professional who described her as ‘a leader’ and that she was taking the home ‘forward’. One staff survey commented that there was ‘a lot of trust between staff and matron’ and that she was ‘making a big difference to the home and how it is run’. Quality assurance processes were well established and surveys were undertaken, analysed and action taken on the comments received. The Responsible Individual undertook monthly visits, as required by Regulation 26 of the Care Homes Regulations 2001. A recent survey undertaken in April 2008 gave positive feedback from relatives and visiting professionals. Comments such as ‘ the quality of the care is excellent’, ‘happy atmosphere’, ‘staff very helpful’ and ‘very good’ were seen. Three peoples’ financial records were examined and were completed accurately and cash held corresponded with the written record. There were receipts available for identified purchases. Cash was stored securely. The administrator stated that no-one in the home was acting as appointee for anyone. Staff supervision took place approximately eight weekly. Staff spoken with confirmed this and there were written records available of supervision sessions. These showed how any issues were discussed and plans put in to action for improvements. Five of the six staff surveys responded that they ‘always’ received the right support and one responded that they ‘usually’ did. One commented that ‘supervisions are done on all staff regularly’. 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. However, it also stated that some staff were out of date and the training records seen confirmed this. Infection control and fire safety were the two main areas needing completion or updating. The manager stated that a new training provider had been arranged and it was anticipated that all staff would be updated in the next twelve months. Staff spoken with confirmed that this training took place. Rutland Manor DS0000002162.V365769.R01.S.doc Version 5.2 Page 25 The written information also stated that regular maintenance of equipment took place that included fire equipment in February 2008, the heating system in November 2007, hoists in April 2008 and portable electrical appliances in September 2007. Accident records were available and also included a monthly audit of how many accidents had occurred. Rutland Manor DS0000002162.V365769.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 X X 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 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 3 X 2 X X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 2 Rutland Manor DS0000002162.V365769.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 (1) Requirement There must always be a specific care plan in place where a risk is identified. Timescale for action 01/08/08 2. OP29 19 (1) (b) (i) Schedule 2 Recruitment information must 01/07/08 identify gaps in employment and the reason for gaps must be explained prior to staff commencing employment in order to fully meet the requirements of Schedule 2 of the Care Homes Regulations 2001. This requirement had a timescale of 01/08/07, which has not been met. Timescale extended. All staff must have a POVA First 01/07/08 check in place prior to commencing employment to fully safeguard people living in the home. Mandatory health and safety training must be updated for all staff, particularly fire safety training and infection control training. DS0000002162.V365769.R01.S.doc 3. OP29 19 (1) (b) (i) Schedule 2 18 (1) (c) (i) & 13 (3) 4. OP30 & OP38 01/09/08 Rutland Manor Version 5.2 Page 28 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. 3. Refer to Standard OP12 OP14 OP15 Good Practice Recommendations There should be consideration given to making regular arrangements for people to go on trips and go outdoors. All staff should be familiar with the Mental Capacity Act 2005 and its implications for care settings. There should be more options available for people on special diets, particularly alternative protein sources for people on vegetarian diets. A privacy curtain should be fixed in the downstairs bathroom. The home should obtain a copy of the Department of Health guidance ‘Essential Steps’ to assist in the control of infection. 4. 5. OP21 OP26 Rutland Manor DS0000002162.V365769.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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. Extracts may not be used or reproduced without the express permission of CSCI Rutland Manor DS0000002162.V365769.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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