Inspection on 23/06/08 for Rutland Manor Nursing Home

This inspection was carried out on 23rd June 2008.

CSCI found this care home to be providing an Adequate 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 Nursing Home 22/06/09

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 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Rutland Manor Nursing Home 12-14 Rutland Road Ellesmere Park Eccles M30 9FA Lead Inspector Elizabeth Holt Unannounced Inspection 23rd and 25th June 2008 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Rutland Manor Nursing Home DS0000065994.V366120.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 Nursing Home DS0000065994.V366120.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 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.V366120.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 4th January 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.V366120.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 Monday 23rd June and Wednesday 25th June 2008. 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 in January 2008 to tell us what they thought they did well, and what they need to improve on and therefore a further one was not requested before this inspection. An improvement plan, completed by the acting manager was submitted to the Commission in May 2008. This described the action being taken to make improvements and address the requirements made following the inspection in January 2008. We considered the responses and the information the manager provided and have at times referred to this in the report. Before the site visit residents, relatives, staff and health professionals were sent surveys asking them to comment on the service. Six surveys were returned from residents/relatives and six surveys were returned from staff and 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 a new acting manager had been appointed who was about to start working his period of notice before leaving his position and the provider was going to propose a new 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. At the time of this visit one allegation of poor care practice was being investigated under Salford Council’s Adult Safeguarding procedures. This has progressed and has been concluded with improvements needed to the record keeping held by the home. Two further concerns/allegations have been made under Salford Council’s adult safeguarding procedures and these are being investigated. Rutland Manor Nursing Home DS0000065994.V366120.R01.S.doc Version 5.2 Page 6 Since the last inspection an application to reduce the numbers of residents accommodated at Rutland Manor from 39 to 30 was approved. What the service does well: What has improved since the last inspection? Since the last inspection there have been some improvements made to the care plans, risk assessments, the food and fluid intake recording and records of residents’ weights. The care plans provided evidence that other health care professionals and services were provided to residents and the forms were being kept up to date in the care plans. An infection control audit and an environmental health audit had been carried out since the last inspection and improvements have been made to policies and procedures following these. Two staff have started the National Vocational Qualification level 2 in care since the last visit and training in blood sugar monitoring has been carried out for some staff. The manager had started to review the induction programme for new staff in line with the Skills for Care induction. Rutland Manor Nursing Home DS0000065994.V366120.R01.S.doc Version 5.2 Page 7 The shortfalls in the fire door at the top of the basement stairs noted at the fire officer’s inspection have been addressed. Regulation 26 reports are being sent to the Commission to show that the provider is monitoring the home. What they could do better: Prospective residents should be involved in a full assessment of their needs before they move in, and in agreement with their plan of care The care plans would benefit from being more person centred and specify the personal preferences of the residents and how the staff could support them to have their needs met. The staffing levels should be reviewed to ensure the residents’ needs come first. The manager must consider how residents could receive the necessary one to one time to make sure their individual needs and care preferences are met. We found that there were shortfalls in the medicines record keeping. Improvements were needed to the records to show the receipt of medication into the home, there were no signatures for the previous month (May 2008), and there were some ‘gaps’ in these records for the current month (June). It was of concern that there were no arrangements in place for the safe disposal of unwanted medicines and no records were made for the disposal of unwanted medicines. Shortfalls in accurately filling in forms in relation to diet and nutrition may lead to residents’ needs not being met. An audit must be carried out of pressure relieving equipment provided and worn cushions and covers replaced as necessary. Although there is a staff member providing two hours, three days a week and there are some improvements in the activities provided. The care plans should include the social needs and wishes of the residents to make sure suitable and appropriate activities are provided to meet their needs and records should be available to show individual activities that have been carried out. The manager needs to make sure a system is in place to evaluate the quality of the services provided at the care home. This system should involve consultation with residents and their representatives. An audit of accidents/incidents should be carried out to see if any strategies can be put in place to reduce the risk of accidents to residents or staff. Rutland Manor Nursing Home DS0000065994.V366120.R01.S.doc Version 5.2 Page 8 The manager needs to make sure a system is in place to evaluate the quality of the services provided at the care home. This system should involve consultation with residents and their representatives. Policies and procedures must be updated on a regular basis in line with any current changes in legislation and practice. Training for staff should be considered in dementia care in order to meet the needs of the residents accommodated. 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 Nursing Home DS0000065994.V366120.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.V366120.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3 and 6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Prospective residents are given some information about Rutland Manor. Pre admission assessments are not carried out in such a way as to ensure the care needs and wishes of prospective residents can be met in full. EVIDENCE: A Statement of Purpose was available that provides new and existing residents with information about the home. Some of the information needed updating to provide prospective residents with information they need to make an informed choice about where to live. At the time of the visit the service user guide could not be found. This document relating to the environment and the facilities available should be available to prospective residents. There had been no pre admission assessments completed since the last inspection. The pre admission information was looked at for a resident who had initially been admitted for respite care and had then remained in the home Rutland Manor Nursing Home DS0000065994.V366120.R01.S.doc Version 5.2 Page 11 for a longer period of time. Information available did not show a full assessment of needs by the manager. An investigation under Salford Council’s Safeguarding Adults Team which has concluded since the last inspection highlighted that there were shortfalls in the pre admission information obtained for a resident who was admitted from hospital. The manager must provide a more 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 and the home is suitable for the resident. Following a review of the responses from the surveys, three relatives commented they “usually” get enough information about the care home or agency to help them make decisions and two said they “sometimes” get enough information. One relative who responded in the survey stated that they did not receive enough information about the home before they moved in. The home does not provide intermediate care. Rutland Manor Nursing Home DS0000065994.V366120.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The care plans and practices for monitoring the healthcare needs of residents are not consistent. This means that residents’ personal, health care or social needs may not be met. Residents’ health is potentially at risk of harm because of poor medication administration and management. EVIDENCE: The care files of three residents were looked at and the resident to whom the care plan belonged to was spoken to. This visit to Rutland Manor showed some improvements in both care practice and care planning and the requirement made at the last inspection for detailed care plans and risk assessments which reflect the on going and changing health care needs of the residents had been addressed in part. We received an improvement plan on the 23rd June 2008, which stated “the residents individual care plans have now been reviewed and updated to show more detailed risk assessments.” During this inspection some concerns that the care plans did not give enough up to date personal information to enable the staff to properly monitor the progress Rutland Manor Nursing Home DS0000065994.V366120.R01.S.doc Version 5.2 Page 13 of the health and personal care needs of the residents and their condition were still seen. The concerns identified were: The care plan for a resident with a chronic chest condition mentions the use of oxygen therapy. This resident is not actually prescribed oxygen and the administration of oxygen in the event of an emergency may not be the appropriate treatment. The nutritional risk assessments highlighted that the home are not screening each resident using a validated nutritional screening tool, such as MUST, (Malnutrition Universal Screening Tool). A care plan evaluation for another resident showed that their blood glucose monitoring was stable. There was no evidence to show that regular blood sugar monitoring checks were being carried out and how this outcome had been reached was difficult to establish. For one resident who had been recatheterised at least four times in six months there was no comment in the evaluation to show there were any concerns re managing the continence of this resident. The care plans would benefit from being more person centred to include the individual likes and dislikes of the person and how the staff could support them to have their needs met. The food and fluid charts were not always fully completed sometimes these had gaps or just stopped being filled in after 3pm, however on the day of this visit they were completed fully. Shortfalls in the lack of information for staff has the potential for staff to not be able to act appropriately if a resident’s intake or output was poor and has the potential to lead to shortfalls in the monitoring of the residents wellbeing. Two of the resident’s pressure relieving cushions was in a worn state and need replacing. An audit of all pressure relieving equipment must be carried out to ensure residents are seated on equipment that is of an acceptable standard and meets their needs. Before the site visit the CSCI sent surveys to residents and relatives asking about their views of the home. Five relatives responded and, of these one said the care home “always”, three “usually” and one “sometimes” meets the needs of their friend/relative. All five relatives said the care “usually” gives the support or care to their relative/friend that you expect or agree. One relative replied in the survey that their relative “usually” received the medical support they needed and added, “but have to ask sometimes to get a doctor”. During the visit a discussion with one of the residents highlighted concerns in the following areas; the length of time it takes for the staff to answer the buzzer, “they can go off for up to 15 minutes at a time and at night it can be up to an hour”, he expressed concerns about the high volume often on the Rutland Manor Nursing Home DS0000065994.V366120.R01.S.doc Version 5.2 Page 14 television which was not to the benefit of the residents and he felt that in relation to activities that met his needs they “did not really exist”. 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. Administration of medicines was observed. This was done with care and records were completed at the time of administration to each person. However, it was of concern that some people had their medicines quite late in the morning. This means that where medicines are repeated later in the day the time between doses may be too short. Residents’ health could be at risk if medicines are given too close together. We looked at medicines record keeping and found weaknesses that made it impossible to track the safe handling of medicines at the home. No records were made to show the receipt of medication into the home for the previous month (May 2008), and there were some ‘gaps’ in these records for the current month (June). It was of concern that no records were made for the disposal of unwanted medicines. Additionally, there were no arrangements in place for the safe disposal of unwanted medicines with a Waste Contractor. Records of administration were sometimes inaccurate. We saw one record that impossibly showed that more doses of an antibiotic had been given than actually received and another record that impossibly showed that all the antibiotic tablets received had been given, when three remained in the bottle. On the visit day one person had not been given their morning medicines because nursing staff thought that there were none left to give. But the doses could have been given because a supply was later found in the medicines trolley. At the previous visit concerns were raised about medicines being ‘potted up’ and not administered. Similarly, during this visit we found a pot containing three tablets, staff spoken with did not to know whom they belonged. This means someone has missed these doses of medication. Not administering medicines as prescribed could affect people’s health and wellbeing. We asked about the application of prescribed creams. Nursing staff explained that care staff applied the creams but nurses signed the records to show they had been applied. It was recommended that NMC guidance (nurses professional guidance) be followed about the delegation of tasks to care staff, and that records should be signed by the person actually carrying applying the cream. We looked at records for communication with healthcare professionals, such as doctors. We saw Nurses had started to seek advice for one person who Rutland Manor Nursing Home DS0000065994.V366120.R01.S.doc Version 5.2 Page 15 regularly refused a prescribed nutritional supplement drink (about two weeks previously) but had not continued to follow this up and a response had not been recorded. Care needs to be taken to ensure concerns are promptly followed-up and the outcomes recorded to ensure if needed, changes are made to people’s treatment. The medication administration records for two people prescribed inhalers had been amended by nursing staff to show they should be given ‘when required’. We could find no evidence that GP advice had been sought about making this change. To help ensure medicines are administered as prescribed clear records of any verbal dose changes should be clearly recorded and followedup. A copy of the homes medication policy was not available for reference during the visit, but the acting manager later phoned to say it was now in place. It is important that the policy is available to provide written guidance for staff in the safe handling of medicines at the home. Regular written audits (checks) of medication handling were not carried out, but the manager said this was planned. It is important that regular audits are carried out to help ensure medicines are safely handled and any areas for improvement are identified and addressed. Rutland Manor Nursing Home DS0000065994.V366120.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is adequate. This judgement has been made using available 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. The activities organiser said some of the residents liked to go out however she had not managed to provide any trips out yet. A number of residents were seen to be sitting in the lounge with nothing to do and with little interaction Rutland Manor Nursing Home DS0000065994.V366120.R01.S.doc Version 5.2 Page 17 from anyone for periods of time. 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. 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. One staff member said, “the resident liked to talk to herself in the mirror.” There is the possibility this is the residents behaviour because she is not experiencing sufficient stimulation from other sources. One staff member wrote in the survey, “Carers can help just with basic needs, food, drink and toileting. Most of the time there is no chance to have a conversation with the residents. The work is based on routine and rushing because of the low number of care staff.” In order to promote mealtimes as a social occasion, the staff should encourage residents to sit together when possible Meals are served to residents at individual tables over their lounge chairs. The one large dining table was not in use during this visit as the staff said 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 encourage residents to sit together when possible. In the morning one resident was seen to have her poached egg on toast placed at her table and there was a lengthy time period before the resident appeared. I asked this resident “Did she enjoy her breakfast?” to which she replied that her egg was cold and so she did not eat it. The food provided must be of a temperature that is satisfactory for the residents to eat. Residents who could express a view were positive about the meal provided at lunchtime and one resident said, “I enjoy the meals here, they are like good home cooking.” Relatives spoken to said they were made welcome at the home and the staff did encourage residents to be involved with their relatives. One relative replied in the survey, “It would be nice if clothes were kept to the rooms they belong to and not others wearing them.” Rutland Manor Nursing Home DS0000065994.V366120.R01.S.doc Version 5.2 Page 18 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. Residents and relatives felt able to raise concerns and 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. A number of staff had received training in Adult Protection procedures at the time of the last inspection. Staff spoken to were aware of the appropriate course of action to take in the event of an allegation of abuse. At the previous inspection a need for a training matrix to show the number of staff who have attended training courses was raised. This has been reiterated because this would highlight when staff are due updates or refresher training so this could be monitored. One staff member replied in the survey that, “We were given training when the other manager was here but since then there has been no more training for us”. One complaint in relation to the new management arrangements at the home was made directly to the CSCI since the last inspection. The provider investigated this and it was not found to be upheld. There have been no complaints made directly to the home since the last inspection. Six relatives returned surveys and of these, five said they knew how to make a complaint and there concerns were usually responded to appropriately. One Rutland Manor Nursing Home DS0000065994.V366120.R01.S.doc Version 5.2 Page 19 relative said, “I wouldn’t know how to make an official complaint but have spoken to the manager a couple of times to voice my concerns”. A number of staff had received training in Adult Protection procedures at the time of the last inspection. Staff 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. The allegation investigated under Salford Council’s Adult Safeguarding procedures raised at the last inspection highlighted the need for improvement in the following areas: shortfalls in the assessment information on admission to the home, poor care planning and record keeping particularly in relation to wound care, no use of a nutrition screening tool, shortfalls in food and fluid monitoring, no evidence of senior staff auditing the care plans and a lack of use of the knowledge and expertise of other professionals within the Community Health team. Since the last inspection one further allegation has been investigated under Safeguarding procedures and this was found not to be upheld. Rutland Manor Nursing Home DS0000065994.V366120.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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 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 home was clean, comfortable and homely for the residents living there. EVIDENCE: The home was generally clean, comfortable and homely for the residents living there. The main lounge area had the following shortfalls, the curtains were not all appropriately hung and some of the chairs in the lounge were unclean. The facilities include an internal passenger lift to all floors. The décor and furnishings were comfortable and homely. Residents said they were able to have some of their own furniture in their bedrooms. One resident who had a lot of personal possessions in his bedroom said, “This is my home and I like having the things that interest me around me”. A partial tour of the home was carried out that included a number of bedrooms and bathrooms. Bedrooms were personalised with photographs and pictures. Rutland Manor Nursing Home DS0000065994.V366120.R01.S.doc Version 5.2 Page 21 A cleaning programme is in place and the home was clean and free from unpleasant odours. Plans were in place to replace some of the carpets and new chairs had recently been provided for visitors. Observation of the use of the hoist for moving and handling highlighted that residents do not have their own slings solely for their personal use. A requirement was made in order to reduce the risk of cross infection. Rutland Manor Nursing Home DS0000065994.V366120.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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The number and deployment of staff levels must be reviewed to make sure the care and health and safety needs of the residents are being met in full. Shortfalls in the number of staff may lead to residents needs not being met. EVIDENCE: On the day of the site visit there was the acting manager and three care workers until 8pm. The manager and two of the care workers were on long days. At night there is one registered nurse and two care workers. Other staff on duty were a cook, a domestic, a laundress and the handyperson. At the time of the visit there were 21 residents accommodated in the home. From observations made during the visit and comments from the staff there was not enough staff to meet the needs of the residents. Residents had to wait at times to have their needs met because the second care worker was not available to assist. The demands on the three care workers were challenging for them to meet the individual needs of the residents accommodated. At the time of this visit the dependency needs of the residents showed that two staff were needed to assist with the moving and handling and hygiene needs of ten of the residents accommodated. Two residents made comments that staff were too busy to be able to sit down and have a chat with them. Rutland Manor Nursing Home DS0000065994.V366120.R01.S.doc Version 5.2 Page 23 In the first lounge two residents were observed sleeping in their chairs since 9.30am and a number of residents in the main lounge spent lengthy time periods dozing. At just after 11.00am the manager had to awaken the two residents to give them their prescribed medication. One of the carer workers said the night staff assist these two residents up and a number of others and they believed that sometimes it can be as early as 05.00hours when they are awakened. The care plans should specify the personal preferences for rising and retiring and the needs of the residents must be reviewed in line with the staffing levels to ensure the residents’ needs come first. The manager must consider how residents could receive the necessary one to one time to make sure their individual needs and care preferences are met. One relative replied in the survey saying, “If they are short staffed my mother is sometimes left to feed herself which she has difficulty with. They take her to the toilet in a morning and after lunch but not sure of any other time because she can’t tell them she wants to go.” During the site visit we had some concerns that staff were not checking or able to spend time with some of the residents who spent the day in their bedroom. We checked one of the residents on a number of occasions on the first day of the visit and the staff member said she was still in bed late morning because the second care worker was not free to assist her and was busy with another resident. This resident appeared to enjoy being chatted to and it was of concern as to whether she received sufficient stimulation during the course of the day. The care plans would benefit from being more person centred to include the individual likes and dislikes of the person and to show the care staff how their needs could best be supported. One resident was quite clear in expressing that his needs were not being met in the care home and he was feeling a burden to the staff due to his requests/demands for assistance to transfer into his wheelchair to go outside. Six survey forms were filled in by staff members and returned to the CSCI. Three staff responses said “never” to “Are there enough staff to meet the individual needs of all the people who use the service?” “two” and one said “usually.” Additional comments were “We work understaffed which is not right”, “There are a lot of clients who need to carers to assist them, as there are three carers on duty and sometimes two, the clients have to wait and not all relatives are understanding. Some carers get residents up on their own when two are required.” One relative replied in the survey, “the staff do listen and act on what you say but not always straight away because of staff shortages”. Following the concerns discussed during the visit on day one in relation to the numbers of staff on duty, the acting manager said the homeowner had agreed to increase the care workers in the daytime by one person. The manager must review the staffing levels and the skill mix of the staff to make sure the needs of the residents are appropriately met. Rutland Manor Nursing Home DS0000065994.V366120.R01.S.doc Version 5.2 Page 24 Three staff files were looked at each file contained the appropriate information in line with the Care Homes Regulations 2001. The improvement plan showed that 87 of care staff have completed a National Vocational Qualification level 2 in care and two staff were currently following this course of study. At the previous inspection a need for a training matrix to show the number of staff who have attended training courses was raised. This has been reiterated because this would highlight when staff are due updates or refresher training so this could be monitored. One staff member replied in the survey that, “We were given training when the other manager was here but since then there has been no more training for us”. Since the last inspection two staff have received training in blood glucose monitoring and the improvement plan showed that other staff will be scheduled to attend this training. Rutland Manor Nursing Home DS0000065994.V366120.R01.S.doc Version 5.2 Page 25 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 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. 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 of the residents are met. EVIDENCE: Since the last inspection the home had appointed an existing staff member to take over the day-to-day running of the home. Comments from the staff surveys were not all positive about the management style of the acting 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 residents. A discussion with the acting manager highlighted that “he did not feel this was the job for him at the present time”. Since this inspection the Commission Rutland Manor Nursing Home DS0000065994.V366120.R01.S.doc Version 5.2 Page 26 have been informed that a new manager has been recruited and is due to start at the home in July 2008. A discussion with the manager and a review of the duty rotas did not show the manager was receiving sufficient supernumerary time for him to be able to carry out duties other than being the nurse in charge of the home when he was on duty. The management arrangements must include the manager having some time in order to manage the home in the best interests of the residents. On the day of this visit the manager was kept busy dealing with the running of the home and managing the medication that there was little observed of him directly supervising the care staff and overseeing the care delivered to residents. There were no records available to show that staff had received formal supervision sessions since the last inspection. Records of maintenance of the fire system and fire doors are kept. From the tour of the premises it was seen that some areas of health and safety were not met in full. One of the fire doors did not close flush against its rebate on the ground floor, this was raised during the visit to be addressed. Staff were recording accidents in an appropriate format but it was not evident these were being audited to show if any strategies could be put in place to minimise the risk to residents. As raised at the last inspection there was no evidence that a quality assurance system based on seeking the views of relatives, residents and visiting health care workers was in place. There was no example of the home’s self audit questionnaire or any results to confirm this is in place and the acting manager could not find any results during this visit. This requirement has been reiterated. Procedures for a sample of residents’ money were looked at and recommendations were made to improve the methods to show the residents’ individual expenditure in a more appropriate way. Although there is evidence some improvements have been made the residents will benefit from a full time manager to take on the leadership for the home to oversee the management of care practices, the management of the residents and the supervision of the staff. Rutland Manor Nursing Home DS0000065994.V366120.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 2 X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X 3 X 2 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 2 X 2 Rutland Manor Nursing Home DS0000065994.V366120.R01.S.doc Version 5.2 Page 28 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP3 Regulation 14 Requirement 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 to make sure the home is suitable for the resident must be provided. The nutritional risk assessments highlighted that the home are not screening each resident using a validated nutritional screening tool, such as MUST, (Malnutrition Universal Screening Tool) to prevent malnutrition. An audit of pressure relieving equipment provided must be made and replacements made as needed. Medication must be safely administered as prescribed To help ensure medicines are safely handled: complete and accurate records of all medicines received into, administered and disposed of need to be maintained. Each resident who is assessed as needing transfers using the hoist DS0000065994.V366120.R01.S.doc Timescale for action 05/08/08 2. OP8 14(1)(a) (2) schedule 3 (3) m 05/08/08 3. OP8 16(1)(2)c 30/07/08 4. OP9 13(2) 30/07/08 5. OP26 13(3) 01/08/08 Rutland Manor Nursing Home Version 5.2 Page 29 6. OP36 18(2) 7. OP27 18(1)a 8. OP33 24(1) must be provided with an individual sling for personal use to reduce the risk of cross infection. A record must be kept to show 30/07/08 that staff supervision covering all aspects of practice, career development and philosophy of care in the home takes place. So that residents receive the 30/07/08 support and personal care they need the staffing levels and deployment of staff must be reviewed to ensure sufficient, experienced staff are on duty at all times. To allow people and/or their 12/09/08 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. (The previous timescale of the 17/3/08 had not been met.) 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. Refer to Standard OP1 Good Practice Recommendations Sufficient information must be provided to prospective residents for them to make an informed choice about admission to the home. This includes updating the Statement of purpose and providing a Service User Guide. The times that medicines are administered should be monitored and where/if needed arrangements made to DS0000065994.V366120.R01.S.doc Version 5.2 Page 30 2. OP9 Rutland Manor Nursing Home 3. 4. OP10 OP12 ensure enough time is left between doses of the same medicine. Staff should respond to residents 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. It is recommended that policies and procedures are accessible for staff to consult at all times. This should include the policy for medication. The food served should be of a temperature that is satisfactory to meet the needs of the residents. All residents should be provided with appropriate supportive equipment from where they can eat their meals. Training should be provided in areas associated with the conditions relevant to older people so the staff understand the needs of the residents they are caring for. It is recommended the induction programme is reviewed in line with the Skills for Care induction and that a training matrix is developed. It is recommended the acting manager is supported and guided appropriately to manage the care home in the best interests of the residents. Accident records should be audited to identify strategies to minimise risk to residents. The records of money held on behalf of residents should be individually recorded and include the residents expenditure witnessed by two staff members. 5. OP12 6. 7. 8. 9. OP15 OP15 OP27 OP30 10. 11. 12. OP31 OP33 OP35 Rutland Manor Nursing Home DS0000065994.V366120.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Manchester Local office 11th Floor West Point 501 Chester Road Manchester M16 9HU 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 Nursing Home DS0000065994.V366120.R01.S.doc Version 5.2 Page 32 - 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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