Inspection on 04/01/08 for Rutland Manor Nursing Home

This inspection was carried out on 4th January 2008.

CSCI found this care home to be providing an Poor 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 22/06/09

Rutland Manor Nursing Home 23/06/08

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Rutland Manor Nursing Home 12-14 Rutland Road Ellesmere Park Eccles M30 9FA Lead Inspector Elizabeth Holt Unannounced Inspection 4th January 2008 10:00 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.V348582.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.V348582.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 Ms Antoinette Moremi Care Home 39 Category(ies) of Old age, not falling within any other category registration, with number (39), Physical disability (4) of places Rutland Manor Nursing Home DS0000065994.V348582.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. A maximum of 39 service users who require nursing or personal care can be accommodated. Four named service users are under 65 years of age and require care by reason of physical disability. If any of these service users leaves, or reaches the age of 65 years, the registration will revert to OP. 15th September 2006 Date of last inspection 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 39 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 £355.52 and £500.00 per week. There are additional costs for hairdressing, newspapers and toiletries. Rutland Manor Nursing Home DS0000065994.V348582.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 0 star. This means the people who use this service experience poor quality outcomes. This key unannounced inspection, which included a site visit, took place on Friday 4th January 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 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, relatives, staff and health professionals were sent surveys asking them to comment on the service. Five surveys were returned from residents/relatives and five 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. The Commission was informed at this visit that the Registered Manager was currently working her period of notice before leaving her position and they were going to propose a new manager. 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. At the time of this visit one allegation of poor care practice was being investigated under Salford Council’s adult safeguarding procedures. The requirement made at the last inspection had been addressed. What the service does well: The home provides a clean, pleasant and comfortable environment for residents to live in. Residents who could express a view spoke favourably about the environment in which they lived and some residents said they liked Rutland Manor Nursing Home DS0000065994.V348582.R01.S.doc Version 5.2 Page 6 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. The manager carries out assessments of each prospective resident before they are admitted to the home and this information is used to develop the care plans. Residents were registered with a General Practitioner (GP) and did receive professional input from other health professionals. Staff training was said to be good by the staff and they felt they were given opportunities to attend courses that interested them. 87 of care staff at the home have successfully completed NVQ training. Residents spoke positively about the staff team. Staff were heard talking kindly to the residents and were seen to support them during meal times in a sensitive manner. Residents and relatives said the food was good, one resident said, “The meals here are great, and its lovely home cooking”. The home has flexible visiting arrangements to enable residents to have regular contact with their families and friends. What has improved since the last inspection? What they could do better: The Statement of Purpose and Service User Guide should be available to give information about the home to help residents and their relatives make an informed choice about the home and what it offers. The care plans were not detailed enough to give staff the information to deliver the appropriate care and to monitor the care effectively. Shortfalls in the risk assessments and the recording of detailed information may lead to residents’ needs not being met in full. Shortfalls in accurately filling in forms in relation to diet and nutrition may lead to residents’ needs not being met. Rutland Manor Nursing Home DS0000065994.V348582.R01.S.doc Version 5.2 Page 7 The manager should provide a body-mapping tool to show clearly any markings or changes on a residents’ skin. The recording and reporting of any wounds must be monitored to make sure resident’s needs are met. Although the manager has trained two staff members in activities and there are some improvements in the recording of activities carried out by individual residents 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. The system in place for recording staff training should be improved to show that staff have received the mandatory training to make sure they have the skills to carry out their roles appropriately. 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. The sit on weighing scales should be checked for accuracy. The laundry system should be reviewed to make sure the residents receive their clothes back from the laundry in an orderly way. Medicine procedures need improving. 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. 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.V348582.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Rutland Manor Nursing Home DS0000065994.V348582.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents needs and wishes are assessed before they are admitted to the home. EVIDENCE: The pre admission assessments for three residents were looked at. The pre assessment form used showed that an assessment of needs was carried out of prospective residents before they were admitted to Rutland Manor. One of the residents said, “I am settling in well here, it is homely here and the staff are friendly.” Copies of Care Management assessments were available for residents who were admitted under Local Authority arrangements and these were used to start the care plans. The Statement of Purpose and Service User Guide were not available during this visit. These documents should be readily available with all the current Rutland Manor Nursing Home DS0000065994.V348582.R01.S.doc Version 5.2 Page 10 information about the home, the service provided and the facilities the home aims to provide. New residents and their families are encouraged to look around the home before making a decision to move into Rutland manor. The home does not provide intermediate care. Rutland Manor Nursing Home DS0000065994.V348582.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The care planning and risk assessments in place lack detail to provide staff with sufficient information for them to satisfactorily meet the needs of the residents. Shortfalls in the care plans may lead to resident’s needs not being met. EVIDENCE: Three care plans were reviewed as part of the inspection process. The information provided gave some detail about the resident’s needs and how the residents were to be supported however shortfalls identified may lead to the resident’s healthcare needs not being met. In one care plan, information regarding the monitoring of the resident’s blood sugar stated, “regular blood sugar monitoring” and on the chart in the care plan there was no recording since 19/10/06. The nurse in charge said the blood sugar monitoring was not required “that often”, however it was difficult Rutland Manor Nursing Home DS0000065994.V348582.R01.S.doc Version 5.2 Page 12 to assess whether the staff were not recording information that was required. The information held about this resident lacked a specific care plan and risk assessment in relation to the individual having an oedematous calf and how this should be attended to. The nurse in charge said the resident’s General Practitioner was involved in the care however there was no recording in the professional updates in relation to the planned care. This resident looked like her calf was not well attended to and there was no dressing in place where there was evidence of oozing. For one resident the daily statement noted the resident had a vaginal discharge; there was no follow up to this, evidence of treatment sought or outcome recorded. Shortfalls in the recording of information of professional visits may lead to a lack of up to date health care information being available for the staff to act upon. The handwriting in some of the care plans was not always legible. It is recommended that staff write clearly to enable other staff to be able to read the information provided. There was not always evidence of staff taking action when a cause for concern was noted. During the visit concerns were raised in relation to the recordings of the resident’s weights and the filling in and monitoring of food and fluid charts. The weight chart for one resident showed her weight loss had been nine and a half pounds over six months. The care plan for this resident showed they were a “picky eater” and staff spoken to agreed with this. There was little evidence of the food and/or fluid charts being well completed. The nurse in charge commented that only if they had “serious concerns” would they record the intake and output of a resident. For another resident the nutritional risk assessment stated to monitor intake and output however the recordings on the dietary intake forms did not show the resident had received a well balanced, nutritious diet. The associated risk assessment showed “Appetite poor at the moment, supplementary drinks given”, however there was no evidence of any extra fluids offered between meals or after supper. For another resident the resident’s weight record did not comment about any weight loss/concerns about her weight, however in a period of just under four weeks this resident had lost seven pounds in weight. There was a risk assessment which stated, “can go for days without food.” The evaluation assessment states “appetite fair”, continue with plan. A recommendation was made for the sit on weighing scales to be checked for accuracy and for staff to be reminded of the need to ensure residents are weighed with accuracy. A discussion with the nurse in charge highlighted the need to carry out a full audit of the residents’ nutritional risk assessments, weights and needs for supplementary feeding. A record of accurate weights must be maintained where there is a risk of poor nutritional intake identified to ensure that appropriate action can be taken to address any significant weight loss. The medication administration records for two residents recorded to be given nutritional supplements had not had these prescribed by the GP. The evaluation for one resident stated “on a puree diet” however the care plan had Rutland Manor Nursing Home DS0000065994.V348582.R01.S.doc Version 5.2 Page 13 not been updated to reflect the care required since August 2007. This plan of care still recorded “cut food up into small pieces.” The recordings for the use of pressure relieving equipment lacked the specific information of the mattress and there were no charts to show that a checking system was in place to make sure the mattresses are at the right pressure level in line with the resident’s weight assessment. The on-going monitoring and care practices in relation to pressure area care require attention and highlight an area for staff development and training. The actual wound care plans were not well detailed and the evaluations did not reflect the changing health care needs. For one resident the nurse in charge said the pressure sore had developed following return from a stay in hospital. There was no body-mapping tool or re assessment information to show this wound had occurred after a stay in hospital. There was evidence of input from the tissue viability nurse however wound care plans lacked updates following these visits and the use of photographs to assist in the monitoring and review of these wounds. Considerable improvements must be made to the care plans and risk assessments to ensure the documentation clearly reflects the ongoing and changing health, personal and social care needs of the residents accommodated. 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. There was some evidence to show that the plans of care had been drawn up with the involvement of the resident/relative. During the visit we looked at records about medication. The medication administration records (MAR) showed these to be clearly recorded. Shortfalls were noted in that three medicine pots were seen at lunch time with tablets in them. When this was raised with the nurse in charge it was explained that residents had not taken these following the morning medication round. These shortfalls have the potential to put residents healthcare needs at risk as medications should be given at the prescribed time. These medicines had been signed for despite the residents not having taken them. Some medications were handwritten entries on the medication administration records. These were not signed and countersigned by a witness to ensure the entries are correct. There were no Controlled drugs present in the home at the time of this visit. Rutland Manor Nursing Home DS0000065994.V348582.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are given support and some opportunity to exercise choice and control over their lives. EVIDENCE: The home had an open visiting policy and the staff were seen to have a good rapport with the residents in the home. The manager has continued to make attempts to address the shortfall in activities provided and two members of the care team attended a course on activities in October 2006. One of the staff members promotes the residents to move and does exercises to music on a weekly basis. However as raised at previous inspections there was little evidence provided to show that residents had the opportunity to have their social or recreational needs met. In both lounge areas the residents sat with the television as the focus of attention. Since the last inspection there was some improvement in the information about hobbies and interests recorded in the care plans, however a number of the life histories were left empty. One relative recorded Rutland Manor Nursing Home DS0000065994.V348582.R01.S.doc Version 5.2 Page 15 in the survey,” there are not as many activities as there used to be,” whilst a staff member commented that attempts to involve residents in activities is “very difficult as they do not want to join in”. 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. One resident said, “I don’t mind where I eat so long as the food stays as good.” In order to promote mealtimes as a social occasion, the staff should encourage residents to sit together when possible. One resident was very positive about the food. “I enjoy the meals here.” The meal on the day of the visit was poached fish for lunch with potatoes and vegetables. One resident was having an alternative meal of meat and potato pie with peas. The dessert was rhubarb custard or yoghurts. A relative responded in the survey, “good chef with good home cooking”. During this visit some residents were seen reading the daily newspaper, which residents said they requested each day and enjoyed reading. One of the relatives commented in the survey that her relatives, “clothes are sometimes found on the wardrobe floor. Her blankets have been found on other residents and clothes seem to disappear.” Rutland Manor Nursing Home DS0000065994.V348582.R01.S.doc Version 5.2 Page 16 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 number of staff had received training in Adult Protection procedures and two staff spoken to were aware of the course of action to take in the event of an allegation of abuse. A discussion with the nurse in charge highlighted the need for a training matrix to show the number of staff who have attended training courses. This would highlight when staff are due updates or refresher training so this could be monitored. The CSCI or the home had not been in receipt of a complaint since the last inspection. The home had a copy of Salford Council’s Adult Safeguarding Procedures. At the time of writing the report there was one allegation being investigated under Salford Council’s adult safeguarding procedures, which had not been concluded. Rutland Manor Nursing Home DS0000065994.V348582.R01.S.doc Version 5.2 Page 17 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 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 provides a clean and homely environment. 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 said, “Just look at my room, it is lovely isn’t it?” A partial tour of the home was carried out that included seven bedrooms. Bedrooms were personalised with photographs and pictures. A cleaning programme is in place and the home was clean and free from unpleasant odours. Rutland Manor Nursing Home DS0000065994.V348582.R01.S.doc Version 5.2 Page 18 Rutland Manor Nursing Home DS0000065994.V348582.R01.S.doc Version 5.2 Page 19 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 good. This judgement has been made using available evidence including a visit to this service. There is a stable staff team who are provided with sufficient training to ensure they are competent to meet the needs of residents. EVIDENCE: Evidence from the AQAA showed there was a low turn over of staff, with some staff having been employed for over 3 years. At the time of the inspection the home accommodated 18 residents and one resident was in hospital. On the day of the inspection the staffing numbers appeared appropriate to meet the needs of the residents accommodated. Comments from a relative in the service user surveys highlighted that staff are not always available when you need them. “Sometimes cannot find staff at floor level, maybe near bedtimes. Especially when a few people in the same room as Mum and a patient is distressed.” In response to one of the survey questions asking about communication between staff a staff member commented, “Carers often tell nurses about any problems with the residents, but they don’t always do anything about it on their shift. We don’t have a handover at 2pm either.” A staff member spoken to said; “sometimes I don’t feel like I have enough information about the Rutland Manor Nursing Home DS0000065994.V348582.R01.S.doc Version 5.2 Page 20 residents.” These shortfalls in communication have the potential for residents’ needs not being met. One staff member recorded in the survey that, “One resident who needs feeding, along with other residents on soft diets, can take up to half an hour for one resident. It puts pressure on the staff….to get the residents up as well as toileting residents.” Another staff member responded saying, “There is usually enough staff on at all times but if not we try and work together so the needs do not suffer.” The staffing levels and deployment of staff should be reviewed to see if changes are needed to ensure they are readily available to meet the resident’s needs. Pre inspection information supplied by the manager stated that 87 of care staff had completed NVQ Level 2. Care staff spoken to say they enjoyed study days and courses and they found it valuable in their daily work to keep up to date. One staff member said she had done courses in abuse awareness, manual handling, food hygiene and fire training in the six months she had been at the home. The induction carried out for new staff was based on in-house information. A recommendation has been made for the induction programme to be reviewed in line with the national guidance from “Skills for Care”. One staff member commented in the survey that, “Induction was adequate, but it was a lot to take in, in such a short space of time. It was rushed.” A recommendation has also been made for the manager to keep a training matrix for staff to be able to see at a glance what training had been done and what they were planning to do. The staff files for three staff were looked at and two of the three contained a written application form. The third one contained a list of previous employment (CV) but a detailed application form should be included as part of the application to include a health declaration. Two of the application forms had photocopies of passports and one did not include a photograph. Staff files had evidence of Criminal Records Bureau checks (CRB). During the visit staff were seen interacting with residents in a positive and friendly manner and staff spoken to clearly knew the individual residents well. Rutland Manor Nursing Home DS0000065994.V348582.R01.S.doc Version 5.2 Page 21 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. The home is not currently being managed with sufficient oversight to fully promote the health, safety and welfare of the residents. EVIDENCE: At the time of the visit the registered manager was on leave and was working her period of notice before leaving the home. Comments received from the staff were positive in relation to the guidance and leadership the manager is giving the home. The shortfalls noted in this report highlight the need for more monitoring of the healthcare needs of the residents to effectively manage the home on a daily basis. Rutland Manor Nursing Home DS0000065994.V348582.R01.S.doc Version 5.2 Page 22 The nurse in charge on the day of the visit had a number of years experience in the care of older people and he had been employed for 14 months at Rutland Manor. Due to the changes in management responsibilities of the home, the registered provider must forward copies of regulation 26 visits to the home. Copies of the homes policies and procedures were not available during this visit. These were kept locked away, which is of concern as the staff have no access to these if they needed to consult them on a daily basis. In the pre inspection information (AQAA), the manager had signed to say all policies and procedures were in place however the date when these policies and procedures were last reviewed had not been completed for the majority of these. A recommendation has been made for staff to have access to the policies and procedures and that these are updated as necessary. 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. The home’s self audit questionnaire does not confirm this is in place and the nurse in charge on the day of this visit was not clear whether this had been carried out in the last twelve months. A requirement has been made for this to be addressed. A look at the maintenance records showed that regular checks of fire alarm tests, fire equipment and emergency lighting were carried out. A discussion highlighted the need to sign these appropriately when they have been checked rather than just ticking them. A requirement was made at the inspection carried out by Greater Manchester Fire Service in December 2007 for the fire door at the top of the stairs leading to the basement to be fitted with intumescent and smoke seals. This had not been addressed. An unannounced fire drill was carried out on the 11/12/07 and included a list of staff that had attended this. The Commission are notified under Regulation 37 of the Care Homes Regulations 2001 of some notifiable incidents that have taken place in the home. The Commission have not been notified of one resident who is known to have died recently. The accident records completed were minimal and a discussion highlighted that an audit of these should be held to show if any strategies could be put in place to minimise the risk to residents. The home has a policy and procedure for the management of residents’ finances however these records were not available during this visit. Staff had access to an amount of petty cash as resident’s needs dictated. Records of money held on behalf of residents must be available for inspection. Residents should have access to their money at all times. There was no evidence of management audit of the care planning procedures to ensure residents health care needs were being assessed, reviewed and met. Rutland Manor Nursing Home DS0000065994.V348582.R01.S.doc Version 5.2 Page 23 Rutland Manor Nursing Home DS0000065994.V348582.R01.S.doc Version 5.2 Page 24 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 3 8 1 9 2 10 2 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 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 2 X X 2 Rutland Manor Nursing Home DS0000065994.V348582.R01.S.doc Version 5.2 Page 25 NO 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 OP7 Regulation 12 Requirement The manager must have detailed care plans and risk assessments in place which reflect the on going and changing health care needs of the residents. Any pressure sores or wounds must be clearly recorded and reported and monitored and appropriate health care support provided to ensure the residents’ well being. Nutritional risk assessments must be carried out and where necessary residents’ weights must be recorded clearly and monitored to make sure appropriate professional support is taken in a timely manner. This will ensure the residents in receipt of the service have their nutritional needs met. 3. OP9 13 When medication is administered to residents it should be given at the appropriate times and signed for following administration. This will ensure residents receive the correct levels of medication as prescribed. DS0000065994.V348582.R01.S.doc Timescale for action 22/02/08 2. OP8 13(1) 08/02/08 02/02/08 Rutland Manor Nursing Home Version 5.2 Page 26 4. OP19 23(4)(a) 5. OP33 24(1) In line with the Fire Safety 02/02/08 Inspection in December 2007, the registered person must make adequate arrangements against the risk of fire: Specifically, intumescent and smoke seals for the fire door at the top of the basement stairs. To allow people and/or their 17/03/08 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. So that the progress of how the home is improving can be monitored Regulation 26 inspection visit records must be submitted to the Commission every month until further notice. The records of money held on behalf of residents must be available at all times for inspection. 05/02/08 6. OP33 26(1), (4)(c) 5(a) 7. OP35 17(2) schedule 4 (9) 05/02/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard OP1 OP8 OP8 Good Practice Recommendations The Statement of Purpose and Service User Guide should be available for existing and prospective residents. The weighing scales should be checked to make sure these are accurately recording the resident’s weights. The recording of information of professional visits should be provided to show up to date health care information for DS0000065994.V348582.R01.S.doc Version 5.2 Page 27 Rutland Manor Nursing Home each resident for the staff to act upon. 4. OP12 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 shold be identified in their care plans. It is recommended the laundry system is reviewed to make sure residents receive their clothes in an orderly way. It is recommended that policies and procedures are accessible for staff to consult at all times. So that residents receive the 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. It is recommended the induction programme is reviewed in line with the Skills for Care induction and that a training matrix is developed. Accident records should be audited to identify strategies to minimise risk to residents. 5. 6. 7. OP12 OP12 OP27 8. 9. OP30 OP33 Rutland Manor Nursing Home DS0000065994.V348582.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Central Registration 9th Floor Oakland House Talbot Road, Old Trafford Manchester M16 0PQ 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.V348582.R01.S.doc Version 5.2 Page 29 - 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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