CARE HOMES FOR OLDER PEOPLE
Rutland Residential Care Home Rutland Residential Care Home 51 Marlings Park Avenue Chislehurst Kent BR7 6RD Lead Inspector
Sue Meaker Unannounced Inspection 24th January 2006 10:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Rutland Residential Care Home DS0000061324.V275308.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Rutland Residential Care Home DS0000061324.V275308.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Rutland Residential Care Home Address Rutland Residential Care Home 51 Marlings Park Avenue Chislehurst Kent BR7 6RD 01689 821 560 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) mavand@ntlworld.com Mrs Mavis Fleming Mr Andrew Albert Fleming Mrs Mavis Fleming Care Home 4 Category(ies) of Old age, not falling within any other category registration, with number (4) of places Rutland Residential Care Home DS0000061324.V275308.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 6th September 2005 Brief Description of the Service: Rutland Residential Care Home is a large, well- maintained, detached house that is sited on a corner plot in a quiet residential area in Chislehurst, close to shops, leisure facilities and has good access to public transport. The interior of the home provides accommodation for four elderly residents in well decorated and furnished en-suite bedrooms; there is also a well-equipped separate bath and toilet facilities on the ground floor. The home has a stair lift to the first floor giving easy access for the residents. The home has a spacious sitting room, a dining room and a well-equipped domestic style, kitchen. The home has a secluded garden to the rear, with a variety of shrubs and plants and a lawn area; there is also a patio with garden furniture easily accessible to the residents and their visitors. There is ample car parking space to the front of the property with an in and out driveway. Rutland Residential Care Home DS0000061324.V275308.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was a statutory unannounced inspection that took place over four hours; comprising of a discussion with the owners of the home Mr and Mrs Fleming, conversations with all the four residents and the member of staff on duty. The four care plans were seen and the medication administration records were inspected; the preparation and serving of lunch was observed, and a tour of the house was undertaken. Unfortunately there were no relatives or healthcare professionals to speak to during the inspection, however complimentary letters were seen at the home, these were from relatives of the residents currently in the home. This was a very satisfactory inspection and Mr and Mrs Fleming were both present during the inspection. What the service does well:
It was evident from speaking to the residents that they were very comfortable in the home, they said that they were well cared for, that the facilities the home offered were very good especially their rooms that were decorated and furnished and maintained to a high standard; they also praised the quality and portions of food they enjoyed and said they were always involved in the planning of the weekly menu. The home provides a comfortable, homely safe and protected environment for its residents. Mr and Mrs Fleming clearly understand the personal, health and social needs of their residents and are very experienced in the care of the elderly; they also employ a registered nurse and a an experienced care trained to NVQ 3 standards. This home is to be congratulated on the high standard of care it provides for its residents who clearly expressed their appreciation of the care they receive and the environment of their home. Rutland Residential Care Home DS0000061324.V275308.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Rutland Residential Care Home DS0000061324.V275308.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Rutland Residential Care Home DS0000061324.V275308.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Service users referred to the home must have a comprehensive assessment prior to admission enabling the home to meet the personal, health and social needs of the prospective service user. EVIDENCE: The homes’ owners are now insisting on a comprehensive referral/assessment from the local authority prior to admitting service users; one service user has been admitted and the home has referred the service user back to the care manager as they feel the placement is not appropriate, this has been done in line with the Statement of Purpose and the Statement of Terms and Conditions of the home, and within the trial period of four weeks. When service users are admitted to the home under a private arrangement the homeowners must undertake a complete personal, health and social needs assessment; this assessment must be documented and a copy must be in the service users personal file. Standards 1, 3, 4 and 5 were assessed in the previous report of the 6th September 2006, and were met.
Rutland Residential Care Home DS0000061324.V275308.R01.S.doc Version 5.1 Page 9 Standard 6 is not applicable to this home. Rutland Residential Care Home DS0000061324.V275308.R01.S.doc Version 5.1 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 9 and 11 The home to formulate a policy and procedure relating to the administration of medication ensuring that service users receive medication safely. The death of a service user would be treated in a compassionate and sensitive manner maintaining their dignity; the service users spiritual needs, rites and functions are observed. EVIDENCE: The service users medication is stored in a locked cupboard in the home accessed only by the management and staff of the home. Records are kept of all medicines received and administered for individual service users. The two members of staff have received training in the administration of medication in their past employment and one of the staff members is a qualified nurse. The home does not have a policy and procedure available for the staff to reference. On speaking to the home owners they have not experienced a death in the home for some considerable time; if service users become ill they are admitted to hospital for treatment. The home is aware of the wishes of the service users and their relatives and representatives in the event of their death; the
Rutland Residential Care Home DS0000061324.V275308.R01.S.doc Version 5.1 Page 11 home owners have conversations with the service users and their relatives when they are admitted to the home this is done in a sensitive and compassionate manner taking into account the frailty and cognitive impairment of the service users in their care. Standards 7, 8 and 10 were assessed in the previous report of 6th September 2005, and were met. Rutland Residential Care Home DS0000061324.V275308.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None EVIDENCE: Standards 12, 13, 14 and 15 were assessed in the previous report of 6th September 2005, and were met. Rutland Residential Care Home DS0000061324.V275308.R01.S.doc Version 5.1 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None EVIDENCE: Standards 16 and 18 were assessed at the previous inspection on the 6th September 2005, and were met. Rutland Residential Care Home DS0000061324.V275308.R01.S.doc Version 5.1 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None EVIDENCE: Standards 19, 23, 24 and 26, (standards 19 and 26 identified as key standards) were assessed at the previous inspection on 6th September 2006, and were met. Rutland Residential Care Home DS0000061324.V275308.R01.S.doc Version 5.1 Page 15 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. The home owners and two members of staff are experienced and skilled in caring for the elderly in a residential setting and are able to provide a high standard of care to their service users meeting personal, health and social needs. EVIDENCE: Although the home does not have a written rota, the owners and the two part time staff provide the residents with care 24 hours a day, seven days a week. The owners are very experienced in the care of the elderly and were approved as carers by the local authority in 1987, the home employs two part time staff one of whom is a registered nurse and one who is an experienced carer trained to NVQ 3 standards. The home does not have a written policy and procedure relating to the recruitment and selection of staff, however the owners are aware of the documentation, specified in the National Minimum Standards, relating to this issue and is working towards compliance. The home needs to have copies of this documentation on file in the home and it is recommended that personnel files are set up for the two part time members of staff. Currently no training is provided by the home, both members of staff have previous training and previous experience in the care of the elderly, however mandatory training and the relevant updates should be available and could possibly be accessed via Bromley Social Services; a record needs to be kept in the home relating to this training ensuring that this training is in date;
Rutland Residential Care Home DS0000061324.V275308.R01.S.doc Version 5.1 Page 16 particularly relating to moving and handling, first aid, food hygiene and fire training. Rutland Residential Care Home DS0000061324.V275308.R01.S.doc Version 5.1 Page 17 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33, 34, 35, 36, 37 and 38. The home needs to look at ways in which to improve systems relating to quality assurance, staff supervision and appraisal, record keeping, policies and procedures and health and safety. The home manages the service uses finances in a safely. EVIDENCE: It was evident during the inspection that the owners and staff were aware of how to meet the needs of their residents and that they are experienced in the care of the elderly, they work as a team to provide a good quality of care. It was confirmed by the member of staff on duty during the inspection that the owners of the home were aware of the need to create an open and positive atmosphere within the home making sure that the residents, their relatives and staff felt comfortable with their aims and objectives and philosophy of the home. The service provided to service users is monitored on an informal basis there is no structured, documented quality assurance system in place.
Rutland Residential Care Home DS0000061324.V275308.R01.S.doc Version 5.1 Page 18 Service users financial interests are safeguarded by the homes’ accounting system. Public liability insurance cover is provided at the home and the certificate is on display along with the certificate of registration from the CSCI. The home does have a business and financial plan that is updated annually. Service users who wish to and are able to, hold small amounts of money for personal items. The home does not hold any money in safekeeping on behalf of the service users; these monies are managed either by their relatives or solicitor. Staff at the home do not receive structured, documented supervision and appraisal, however discussions are held with staff on a day to day informal basis. Record keeping is on an ad hoc basis, however medication records are up to date and accurate; the home does not have written policies and procedures that govern the day to day running of the home this is all done on an informal basis with a lot of input from the service users and the staff and management of the home. This is a small home, domestic in style, which endeavours to provide for the health and welfare of the four service users and the two staff. Standards 31 and 32 were assessed at the previous inspection on the 6th September 2005, and were met. Rutland Residential Care Home DS0000061324.V275308.R01.S.doc Version 5.1 Page 19 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 2 10 X 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X X X X X X X X X STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 3 3 2 2 2 Rutland Residential Care Home DS0000061324.V275308.R01.S.doc Version 5.1 Page 20 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. Standard Regulation Requirement Timescale for action 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 OP3 OP9 OP27 Good Practice Recommendations It is recommended that the home either receives or undertakes pre admission assessments for all prospective service users. It is recommended that a medication policy and procedure be formulated and kept in the medication administration file. It is recommended that the home sets up personnel files for the two part time staff employed; to include information required by Schedule 2 0f the National Minimum Standards. It is recommended that the home obtains a relevant policy and procedure relating to recruitment and selection. It is recommended that the home accesses mandatory training relating to moving and handling, fire safety, food hygiene, first aid and Protection of Vulnerable Adults; this training is to be documented on the individual personnel file.
DS0000061324.V275308.R01.S.doc Version 5.1 Page 21 4 5 OP29 OP30 Rutland Residential Care Home 6 7 8 9 OP33 OP36 OP37 OP38 It is recommended that the home implements a quality assurance system. It is recommended that all informal staff and management discussions be documented and an annual appraisal be undertaken and documented. It is recommended that the home reviews their record keeping and obtains policies and procedures applicable to the home. It is recommended that a moving and handling risk assessment be undertaken for each resident; and a fire risk assessment be undertaken by the home. Fire alarm testing, fire training, fire fighting equipment and fire drills to be carried out and documented on a regular basis. Rutland Residential Care Home DS0000061324.V275308.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Sidcup Local Office River House 1 Maidstone Road Sidcup DA14 5RH National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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