Inspection on 22/06/09 for Rutland Manor Nursing Home

This inspection was carried out on 22nd June 2009.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Rutland Manor Nursing Home 23/06/08

Rutland Manor Nursing Home 04/01/08

Rutland Manor Nursing Home 15/09/06

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 15/11/2009.

Key inspection report CARE HOMES FOR OLDER PEOPLE Rutland Manor Nursing Home 12-14 Rutland Road Ellesmere Park Eccles M30 9FA Lead Inspector Elizabeth Holt Key Unannounced Inspection 09:00 22nd and 23rd June 2009 DS0000065994.V376562.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Rutland Manor Nursing Home DS0000065994.V376562.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Rutland Manor Nursing Home DS0000065994.V376562.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Rutland Manor Nursing Home Address 12-14 Rutland Road Ellesmere Park Eccles M30 9FA 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) 0161 707 1218 0161 787 8127 Rutland Care Home Ltd Manager post vacant Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30), Physical disability (4) of places Rutland Manor Nursing Home DS0000065994.V376562.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing (N) To service users of either gender. Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) 30 Physical disability (PD) 4 The maximum number of service users who can be accommodated is 30. Date of last inspection 12th September 2008 Brief Description of the Service: Rutland Manor Nursing Home is located in a residential area of Ellesmere Park, Eccles. The home provides nursing and personal care for up to 30 older people. Accommodation is provided on three floors and there is a passenger lift to each floor. There are two lounge areas, which are suitable for wheelchair users. Both these rooms have wide screen televisions. The home is set within its own grounds with a designated parking area. The motorway network is accessible to the home and provides ease of access for friends and relatives. Fees for the home are between £325.87 and £424.78 per week. There are additional costs for hairdressing, newspapers and toiletries. Rutland Manor Nursing Home DS0000065994.V376562.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 1 star. This means the people who use this service experience adequate quality outcomes. This key unannounced inspection, which included a site visit, took place on Friday 22nd and 23rd June 2009. The manager of the home was not told beforehand of the inspection visit. All key inspection standards were assessed at the site visit and information was taken from various sources which included observing care practices and talking with residents who live at the home, visitors, members of the staff team and the home owner who was present during part of this site visit. We sent the manager a form called an Annual Quality Assurance Assessment (AQAA) before the site visit to tell us what they thought they did well, and what they need to improve on. We considered the responses and information the manager provided and have at times referred to this in the report. Before the site visit residents and staff were sent surveys asking them to comment on the service. One survey was returned from a resident/relative and one survey was returned from a staff member,where possible some of the information has been used in the report. A partial tour of the building was conducted and a sample of care and staff records was looked at, including employment and training records, staff duty rotas and resident’s care plans. Since the last inspection there have been changes in the management arrangements for the home. The Commission was informed before this visit that a new Manager was in post and she planned to put her application in to the Commission to be the Registered Manager. No complaints had been made directly to the home since the last visit; one complaint/concern was received by the Commission in relation to the attitude of the manager since the last inspection. Information provided by the manager of the service prior to the inspection showed that no complaints had been made directly to the home since the last visit. A random inspection visit was carried out by the pharmacist in September 2008 to follow-up concerns about the handling of medication identified during the previous visit to the home. Rutland Manor Nursing Home DS0000065994.V376562.R01.S.doc Version 5.2 Page 6 A requirement was made for the development of the policy and procedures for the safe handling of medication at the home. This had been addressed. The 8 requirements and 10 of the 12 good practice recommendations made at the last inspection had been addressed either fully or in part. Two of the recommendations have been re written as part of this inspection. What the service does well: The home generally provides a clean, pleasant and comfortable environment for people to live in. People who could express a view spoke favourably about the environment in which they lived and some people said they liked their bedrooms and felt the standard of cleanliness in the home was usually good. The atmosphere in the home during the visit was relaxed, friendly and welcoming. People were happy with the staff at the home. One relative said that the care staff, “are the best, they not only care, I feel like they love my Mum so I go away feeling satisfied.” The staff know the needs of the people who live at Rutland Manor well. The home has flexible visiting arrangements and relatives said they were always encouraged to visit and it never mattered whether it was day or night. People spoken to and relatives were generally pleased with the care provided. One person who filled in a survey said they received the care and support they needed and the staff always listened and acted on what they said. Residents and relatives said the food was good, one resident said, “I get the things I like to eat here, the meals are tasty.” Residents were registered with a General Practitioner (GP) and received professional input from other health professionals. Five of the eleven care staff at the home have successfully completed NVQ training and three are working towards this. People who were asked about complaints said they always knew who to speak to if they had any concerns and they were aware of how to do this. People said they found the new manager to be “Professional and approachable in her manner.” What has improved since the last inspection? Since the last inspection information about the home in the Service Users Guide and statement of purpose has been updated. Nutritional risk assessments had been introduced using a validated nutritional screening tool. A system to audit the pressure relieving equipment provided and some replacements had been made. There has been an increase in the number of Rutland Manor Nursing Home DS0000065994.V376562.R01.S.doc Version 5.2 Page 7 slings provided for people who need to use the hoist since the last inspection to reduce the risk of cross infection. There have been improvements in the staff training offered and the courses made available to them. Improvements have been made to the system in place for staff to receive supervision on a regular basis. There have been improvements to the systems in place for the management of medication in the home since the last inspection, including the policy and procedure in relation to the safe handling of medication. There have been some improvements to the environment which included replacing some carpets, curtains and bedding. The programme of redecoration and refurbishment needs to continue. Policies and procedures had been updated since the last inspection. What they could do better: The assessment information has improved since the last inspection but this should be more detailed and person centred where possible to show the likes and full needs of the person. The staff must be made more aware of the need to clearly record any changes in a person’s skin condition or bruising on a body mapping tool and to complete an incident form. Although a risk assessment had been introduced in relation to nutrition there was no procedure in place to show the staff what they should do in the event of a person scoring high on this assessment to guide them as to the action they need to take. There was a shortfall in information recorded in the reviews or the evaluations for some of the care plans looked at. The staff need to make sure the system in place to keep track of medicines is followed. We discussed the need to extend a survey to include the views of visiting professionals. The manager needs to continue to monitor the number and the deployment of staff in the home to meet the needs of the people living at the home. All staff need to have had the mandatory training in fire safety. There were shortfalls in the care plans of recording the individuals’ social, recreational, cultural or religious wishes and some of the life histories were not filled in. The manager needs to provide some more social activities and had plans to recruit a person for this position. Application forms for employment should be reviewed to make sure this includes the request for the dates when a person’s employment started and ended so a person can be asked about gaps in their employment history. Although the manager and deputy have started some auditing of records and care practice within the home this needs to be developed to make sure it Rutland Manor Nursing Home DS0000065994.V376562.R01.S.doc Version 5.2 Page 8 meets the required standard. The manager needs to be able to show how an area will be improved and by whom when shortfalls are identified. An appropriate thermometer to carry out regular hot water outlet temperatures to ensure that people are protected from the risk of scalding should be provided. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Rutland Manor Nursing Home DS0000065994.V376562.R01.S.doc Version 5.2 Page 9 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 Nursing Home DS0000065994.V376562.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1,3 and 6 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are given information about the service and have their needs assessed before moving into the home, so they know their needs can be met. EVIDENCE: Since the last inspection information about the home in the Service Users Guide and the statement of Purpose has been updated. Copies were displayed in people’s bedrooms and a copy was available in the reception area. The brochure about the home was looked at and the manager stated this was in the process of being updated to accurately show the service provided. Where possible people receive information about the service before an offer of a place is made. An exception to this was if someone was admitted as an emergency from the community. In the event of an emergency admission Rutland Manor Nursing Home DS0000065994.V376562.R01.S.doc Version 5.2 Page 11 there was evidence that staff had copies of the Social Services assessments and started their own assessment of the person’s needs once they were in the home. The information gathered started the care plan for this individual. A requirement was made at the last inspection for there to be a detailed assessment of needs with clear information to ensure the staff can meet the individual resident’s needs prior to their admission to the home, must be provided. Pre admission assessments were looked at for three people who had been admitted to the home since the last inspection. Two of the three people had been visited by the Registered Nurse to be assessed to see that the person’s needs can be met before the offer of a place is made. The information looked at showed that a new assessment form had been put in place and there was some improvement in the information provided. One person spoken to confirmed that, “The nurse from here came to see me in hospital before I came here, it was pleasant.” The Annual Quality Assurance Assessment (AQAA) filled in by the manager stated that “Rutland Manor encourages service users and their families to visit the home. If possible the home allows a service user to stay and have lunch so they can get a feel for the place and see the running of the home.” A discussion with the manager highlighted that the assessment information should be more detailed and person centred where possible to show the likes and full needs of the person. One person’s assessment stated, “Personal cleansing help of one staff for all. Moving and handling, two staff for transfers”. It is good practice for a thorough assessment to be completed to enable an accurate decision to be made as to whether the person’s needs could be met in full. The home does not provide intermediate care. Rutland Manor Nursing Home DS0000065994.V376562.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans were available for each person however some shortfalls in the record keeping had the potential to put people at risk of not having their needs fully met. Some improvements were seen in the procedures for dealing with medication. EVIDENCE: The care files of three residents were looked at and the resident to whom the care plan belonged to was spoken with. As raised at the last inspection, this visit to Rutland Manor again showed some improvements in both care practice and care planning and the requirement made at the last inspection for nutritional risk assessments to be introduced using a validated nutritional screening tool had been addressed. A further requirement for an audit of pressure relieving equipment to be provided must be made and replacements made as needed had been addressed. Pressure care equipment was being Rutland Manor Nursing Home DS0000065994.V376562.R01.S.doc Version 5.2 Page 13 monitored by an external agency. A requirement was made at the last inspection for each person who is assessed as needing transfers using the hoist must be provided with an individual sling for personal use to reduce the risk of cross infection. There has been an increase in the number of slings provided for people since the last inspection. At the time of this inspection the new manager had been in post for a few months. The manager explained she had plans to introduce some new care plans for the people who use the service, alongside the current ones but these will provide more detailed information. During this inspection some concerns that the care plans did not give enough up to date healthcare information to enable the staff to properly monitor the progress of the health and personal care needs of the residents and their condition were still seen. In the AQAA the manager wrote, “Care plans have now been updated to the best of our knowledge. It is an ongoing process but I’m sure in the near future our deliverance of care will get better.” The concerns identified were: The care plan for a person showed in the daily statement that she had massive bruising evident on her right arm. Some days later this person was recorded to have a superficial skin tear on their lower right hand. There was no evidence of any action the manager had taken in relation to this information, there was no body mapping tool in place and no incident form completed. For another person the information from the initial assessment had not been transferred or used as part of the person’s care plan, for example due to a dementia type illness they are forgetful and the use of prompting/reminding had not been brought into the care plan. Staff spoken to did state they would use prompting when supporting this person. Some aspects of this person’s social history from the assessment was not recorded and the manager was not aware of this person’s family life. There was no evidence to show there are care plans in place for these two people specifically in relation to their PEG site. One person had a record of some concerns noted by the dietician however the care plan did not show these or record the action staff had taken to address these shortfalls. With the manager and the nurse in charge we discussed the need to make sure care plans are in place for the staff to manage the PEG sites appropriately. We discussed pressure area care and wound management. For one person the information was confusing. The persons wound had healed however there were no body maps, no description of the wound, the size and depth although there was a treatment plan. The evaluation on one month stated that there was a care plan in place. We discussed the need to be able to carry out an audit trail of the care provided and of the responsibilities of the Registered Nurses in relation to record keeping and the guidance from the Nursing and Midwifery council. At the time of this visit the manager stated that none of the people Rutland Manor Nursing Home DS0000065994.V376562.R01.S.doc Version 5.2 Page 14 living at the home had pressure sores although one person was receiving some wound care from the District Nurses. Although a risk assessment had been introduced in relation to nutrition there was no procedure in place to show the staff what they should do in the event of a person scoring high on this assessment to guide them as to the action they need to take. For another person the nutritional and pressure risk assessments were in place but these had not been signed or dated. A recommendation was made for the staff to have some written guidance in relation to the action they should take. There was a shortfall in information recorded in the reviews or the evaluations for some of the care plans looked at. For one person who was fed via a tube overnight, the next review was recorded as needed on the 1/6/09 and there was no record to suggest this had been carried out. The care plan stated they required daily oral care however again there was no comment on the condition of this person’s mouth. For another person the information written in the risk assessment was confusing. There were risk assessments in place for the use of bed safety rails and pressure sore prevention and a bed audit showed this person was nursed on an airflow mattress/transitional bed. There was however no care plan in place to show the action staff had taken and how they were supporting this person on a day to day level. A review of some of the care plans showed the need to make sure each file had a photograph of the person to assist staff in the identification of people living at the home. The manager did say that they were due to address this. Shortfalls in the information recorded in the care plans for individuals being supported may lead to people’s needs not being appropriately met. Administration of medicines was observed. A requirement made at the last inspection was for medication to be safely administered as prescribed. A sample of medicines and records were looked at, a record was made of medicines received into the home and the records were seen to be accurate for medicines administered and disposed of. This was done with care and records were completed at the time of administration to each person. A recommendation was made at the last inspection for the timing of when medicines were being given out to be reviewed to make sure there was a sufficient gap between medicines administered to people. This was seen to be satisfactory during this visit as people had their medicines around the mealtimes. The staff need to make sure the system in place to keep track of medicines is followed. For one person there was a record of there being no tablets of a sedative left and the person had not been given the medication. These had been recrdered however in another bottle a further seven tablets were in the Rutland Manor Nursing Home DS0000065994.V376562.R01.S.doc Version 5.2 Page 15 medicines trolley for this person. This can make it difficult to track medicines and account for them. The records showed a person had recently received an annual dental and optical assessment and a discussion was held with the manager as to how she plans to monitor these needs for each person living at the home. We discussed oral care and the way in which the staff support people to clean their teeth. Some people looked like their teeth were not regularly cleaned and one person said, “Oh I clean them when I remember.” From observations made during the visit and discussions with some of the staff members it appeared the staff were respectful towards the residents in the way they spoke to them and how the residents were approached. The staff clearly knew the residents well and had a good rapport with them. There was some evidence to show that the plans of care had been drawn up with the involvement of the resident/relative. Staff generally responded to people in a timely manner so their needs could be met and staff were seen to respond to the buzzers when a person requested assistance. Staff were seen talking to people in a respectful way. For one person whose socks were visible well below her skirts hem line and looked very tight around her calves. This was brought to the attention of the staff who addressed this. One person said, “I feel the staff look after me very well here and they are kind and considerate towards me.” . Rutland Manor Nursing Home DS0000065994.V376562.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some opportunities for residents to take part in social activities exist but shortfalls in the care planning in relation to their social and recreational interests means these needs may not be met. Residents were provided food, which they liked. EVIDENCE: The home had an open visiting policy and the staff were seen to have a good rapport with the residents in the home. At the time of this visit a member of the care team has six hours a week to provide activities in the home. A discussion with this individual showed her enthusiasm for the role and the pleasure some of the residents gained from the activities she encouraged. Some of the activities held recently included celebrating birthdays, painting, board games, quizzes and baking and arts and crafts. Photographs of some of the activities and events were displayed in the hallway and some of the residents said they enjoyed having something to do. During these two visits there were no signs of any activities but people were seen to be encouraged to Rutland Manor Nursing Home DS0000065994.V376562.R01.S.doc Version 5.2 Page 17 watch a particular programme on one of the four televisions in the large conservatory. Some people were clearly not watching the television but these were kept on throughout the day. The staff should remember to turn these off if people are not choosing to watch anything. For one person the assessment on admission stated, “Wants to go out.Would like some activities.” The assessment showed no further recording of this person’s likes and dislikes. In the AQAA, the manager stated that she was “working with the activity organiser to try and improve the home’s daily life and activities with more variety of choice.” Activities and stimulation for residents living in the home should continue to be addressed to maintain the improvements made. As raised at the last inspection there needs to be some further effort to find out the likes and dislikes of the residents and to provide some more appropriate and stimulating activities for the residents living at Rutland Manor. There were shortfalls in the care plans of recording the individuals’ social, recreational, cultural or religious wishes and some of the life histories were not filled in. The lack of written social assessment information makes it difficult to establish if the lifestyle experienced in the home matches their expectations. As raised at the last inspection there are a number of residents accommodated with some level of confusion or dementia type illness and these residents were left for periods of time with little or no stimulation. A number of people remained in their bedrooms for the day and it was difficult to establish the time the staff had to visit these people and spent time with those who chose to spend the time in the dayroom. A discussion was held with the manager about the number and deployment of staff on duty to meet the needs of the people living at the home. The relative of a person who has been in the home for a number of years stated, “We wouldn’t have Mum anywhere else, they don’t just care they love her. The staff are great. We want her cared for properly which is what they do” In order to promote mealtimes as a social occasion, the staff should encourage residents to sit together when possible The meal on the day of this visit looked appetising and people who expressed a view said, “The food is good and tasty.” Meals continue to be served to residents at individual tables over their lounge chairs. The manager stated that she had encouraged people to eat at a dining table however when asked the residents preferred to eat on their own. As raised at previous inspections in order to promote mealtimes as a social occasion, the staff should continue to encourage residents to sit together when possible. A recommendation was made at the last inspection for the food to be served at a temperature that is satisfactory to meet the needs of the residents. People spoken to said , “the food was warm and tasty.” Rutland Manor Nursing Home DS0000065994.V376562.R01.S.doc Version 5.2 Page 18 Relatives spoken to said they were made welcome at the home and the staff did encourage residents to be involved with their relatives. Rutland Manor Nursing Home DS0000065994.V376562.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People felt able to raise concerns and these would be listened to. Policies and procedures are in place to protect residents from harm. EVIDENCE: A complaints procedure is available in the Statement of Purpose and one is on display in the home. The one person who returned a survey said they knew who to speak to if they had any concerns and they knew how to make a complaint. A number of staff had received training in Adult Protection procedures at the time of the last inspection and the manager stated some further training was planned over the next few months. Two staff members spoken to were aware of the appropriate course of action to take in the event of an allegation of abuse. The home had a copy of Salford Council’s Adult Safeguarding Procedures. A complaints record was available although there have been no complaints made directly to the home since the last inspection. One person said, “I feel safe here and the staff are marvellous.” In the AQAA the manager stated that listening to the views and opinions of people who live here and their families is important, this was confirmed by relatives spoken to during the visit. Rutland Manor Nursing Home DS0000065994.V376562.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People would benefit from the planned redecoration and refurbishment programme to provide a comfortable, homely environment to meet their needs more fully. EVIDENCE: A partial tour of the home was carried out. The home was generally clean, comfortable and homely for the residents living there. In the AQAA the manager stated, “Some service users have had new chairs. New curtains have been put up in the conservatory. Rooms have had new bedding, carpets have been replace in some areas.” Bedrooms were personalised with photographs and pictures. Rutland Manor Nursing Home DS0000065994.V376562.R01.S.doc Version 5.2 Page 21 The manager stated that plans are being put into action for redecoration and some refurbishment to include updating the bedroom furniture for some people. These improvements would make the environment better for the people living at Rutland Manor. During the partial tour of the building some shortfalls were seen, the main bathroom on the ground floor lacked a shower curtain and a homely feel. The main lounge/conservatory area had new curtains however these were not all appropriately hung. Some of the chairs in the lounge were unclean and some of the small tables had chips in them. The partial tour showed that the downstairs toilet had missing tiles at the back and the walls would benefit from being painted. A visitor to the home made a comment that “Everything is tacky to touch including the tables and chairs and the TV screens are often filthy. Whilst we appreciate the staff are very busy it would feel better if you felt everywhere was clean. I would not complain about it because Mum is very well cared for.” We discussed the need for plans to be made for a sluicing disinfector, the current practice involves the staff rinsing the commode buckets in the upstairs sluice room. This has the potential to put people at risk of cross infection and serious consideration should be given to an appropriate disinfector. Rutland Manor Nursing Home DS0000065994.V376562.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28 and 29 and 30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Rutland Manor receive care and support from competent staff but fluctuating staffing levels may affect the ability of the staff to meet the peoples care needs in full. EVIDENCE: On the day of the site visit there were 21 people living at the home. The manager, deputy manager and three care workers were on duty until 2.00pm. Other staff on duty were a cook, a domestic and a laundress. One person said, “I have been waiting along time to come downstairs because they have been too busy”. She stated she was desperate for a drink of water but was still waiting for this. Another person stated she had been wanting to come downstairs but had “decided to stay put because of the wait.” A discussion was held with the manager about the number and deployment of staff on duty to meet the needs of the people living at the home. (see Daily Life and Social Activities). A requirement made at the last inspection was made for the staffing levels and deployment of staff to be reviewed to ensure sufficient, experienced staff are on duty at all times. From discussions with staff and a look at duty rotas it was clear there had been four care workers on duty since the last inspection, however this had reduced to three again due to Rutland Manor Nursing Home DS0000065994.V376562.R01.S.doc Version 5.2 Page 23 holidays. The manager stated this was being addressed with the recruitment of some new staff. Although the requirement was met the manager must continue to review the staffing levels and the skill mix of the staff to make sure the needs of the residents are appropriately met. Discussions with the staff team and from observations made during the visit identified that people’s care needs were being met, it was according to one staff member, “Having the time to do anything over and above meeting the basic needs that was difficult to fit in.” Another staff member said, “I don’t always get a chance to read care plans but I would ask the nurse in charge or report anything to them.” The care staff should have the opportunity to spend time to update themselves about the current care needs of the people they are providing care for and use the care plan as a working tool. People living at the home and relatives visiting during the inspection were very positive about the staff team. One person said, “They are just the best. I visit a lot of places but they are great here.” Three staff files were looked at. Each file contained the appropriate information in line with the Care Homes Regulations 2001. A recommendation was made to review the application forms for employment to make sure this includes the dates of when previous employment started or to request a copy of a person’s full employment history. Five of the eleven care workers currently employed hold an National Vocational Qualification level 2 in care and a further three staff are doing this currently. A requirement made at the last inspection for a record to be kept to show that staff supervision was in place covering all aspects of practice, career development and philosophy of care in the home. The new manager had introduced a format for this and the staff had received a formal supervision since the last inspection. Two staff files had copies of the induction checklist which had been signed off by a senior member of the staff team. At the previous inspection a need for a training matrix to show the number of staff who have attended training courses was raised. The manager had addressed this and had made plans for further training. Rutland Manor Nursing Home DS0000065994.V376562.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People and their relatives were confident the new manager is running the home in the best interests of people who live there. Further work is needed to ensure the systems in place to monitor the care practices and record keeping is adequate so that the health and welfare needs of people are fully met. EVIDENCE: Since the last inspection the home have had further changes in the person appointed to take over the day-to-day running of the home. At the time of this visit the new manager had been in post for a few weeks. Since she had been in Rutland Manor Nursing Home DS0000065994.V376562.R01.S.doc Version 5.2 Page 25 post the manager stated she had spent considerable time updating policies and procedures, planning training and staff supervisions, reviewing the care planning system and auditing accident records. She now felt able to start monitoring the care practices and the care procedures in the home and “getting to know the residents well.” The manager said she was planning to start the leadership and management award. She stated that she did plan to submit her application to be registered with the Commission in the very near future. Comments from the staff were positive about the new manager who was being supported by the deputy manager. Some of the shortfalls in this report highlight the need for continued support or guidance for the manager for the well being of the people living at the home. The home needs a period of management stability and continuous leadership in order to manage the home in the best interests of the people living there. Discussions with the manager throughout the two visits showed she had ideas and plans as to how she wanted to develop the service. A requirement made at the last inspection was to allow people and/or their representatives to express their views on the quality and direction of the service. A system of quality assurance must be employed to establish that information and provide the basis for an improvement plan. Since the last inspection the manager has developed a questionnaire to gain the views of residents/relatives. The manager was in the process of analysing the results from these at the time of this visit. We discussed the need to extend a survey to include the views of visiting professionals. A recommendation was made at the last inspection for the accident records to be audited to identify strategies to minimise risk to residents. The manager had introduced a system for this at the time of this visit. The manager and the cook talked about the arrangements in place for the management and security of money belonging to people who use the service. The policy of the service is that people manage their own money where possible; five people currently have their finances managed by the home owner. A discussion was held as to whether the relatives/advocates could take over the management of any of these finances for these people. There was a system in place to show how the resident’s money was managed. This was individually recorded and included the residents expenditure witnessed by two staff members. We discussed the issue re resident’s monies being in non interest bearing accounts and that small commission charges were being passed on to peoples accounts. The home owner visited the home during the visit and stated she would look into this. There were some shortfalls in information provided in the AQAA, for example some of the maintenance equipment was not shown to have been tested or serviced. There was a lack of information provided to show how some of the concerns raised at the last inspection had been addressed. These concerns included issues in relation to care planning, risk assessments and wound Rutland Manor Nursing Home DS0000065994.V376562.R01.S.doc Version 5.2 Page 26 management which have still been assessed as having shortfalls at this inspection visit. The manager did state that it was the first time she had filled in an annual quality assessment form and she was also new to the service which made it quite difficult. Some of the maintenance records were seen. In relation to fire safety there was evidence of fire alarm system checks in place, fire exits, emergency lighting and extinguisher checks. The records for fire drills were not up to date but the deputy manager stated he had done a fire drill and went through this with all the staff on duty approx two weeks ago including the emergency procedure. A recommendation was made for a record of the staff who attended this to be made. The fire risk assessment was in place and the evaluation states the risk assessment remains relevant. The fire extinguishers were last checked in Nov 08. The fire training records for staff were not up to date and staff spoken to said they had not had this in the last twelve months. The manager stated she would address this and since the inspection dates for staff training have been arranged. Water temperature checks were being carried out however the thermometer needs to be a specific one for testing the water. Staff said there was enough equipment within the home to enable them to carry out their jobs safely and staff were seen to be using safe working practices. Rutland Manor Nursing Home DS0000065994.V376562.R01.S.doc Version 5.2 Page 27 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 X 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 X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Rutland Manor Nursing Home DS0000065994.V376562.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? No 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 13(4)c Requirement The staff must be made more aware of the need to clearly record any changes in a person’s skin condition or bruising on a body mapping tool and to complete an incident form in order to safeguard people. To ensure that staff attend regular fire drills and fire safety training so they would know the action to take in the event of a fire in the home. Timescale for action 10/08/09 2. OP38 23(4) d 08/08/09 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 OP3 OP7 Good Practice Recommendations It is good practice for a thorough assessment to be completed to enable an accurate decision to be made as to whether the person’s needs could be met in full. All risk assessments and care plans should be reviewed and monitored to ensure information is current so staff are DS0000065994.V376562.R01.S.doc Version 5.2 Page 29 Rutland Manor Nursing Home 3. 4. 5. OP9 OP10 OP12 updated in relation to the level of support needed. The staff need to make sure the system in place to keep track of medicines is followed so people receive the medicines as prescribed. Staff should respond to people in a timely manner so their needs can be met and their dignity is respected. Activities and stimulation for residents living in the home should continue to be addressed to maintain the improvements made. The social needs and wishes of residents should be identified in their care plans. Consideration should be given to providing a sluicing disinfector to reduce the risk of cross infection. Application forms for employment should be reviewed to make sure this includes the request for the dates when a person’s employment started and ended so a person can be asked about gaps in their employment history. Although the manager and deputy have started some auditing of records and care practice within the home this needs to be developed to make sure it meets the required standard. The manager needs to be able to show how an area will be improved and by whom when shortfalls are identified. An appropriate thermometer to carry out regular hot water outlet temperatures to ensure that people are protected from the risk of scalding should be provided. 6. 7. OP26 OP29 8. OP33 9. OP38 Rutland Manor Nursing Home DS0000065994.V376562.R01.S.doc Version 5.2 Page 30 Care Quality Commission North West Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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