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Inspection on 12/11/07 for Rydal House Nursing Home

Also see our care home review for Rydal House Nursing Home for more information

This inspection was carried out on 12th November 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The ongoing log records kept by staff of how service users were on a day-today basis were detailed and well written. Staff spoken to said there was a good team of staff at the home who communicated well and worked well together. The Expert by Experience reported that all service users and relatives spoken with were full of praise for the home`s manager and the care provided by the staff but all felt that there was "too much to do" for the too few staff on duty and that more staff were needed.

What has improved since the last inspection?

There have been domestic and kitchen staff employed since the last inspection. There are however some issues evident around safe food handling and attention to detail with cleaning in the home. There has been some floor replacement in 3 bedrooms. A new washer and dryer have been installed. Ongoing investment into curtain and furniture replacement is imminent in order to improve the environment.

What the care home could do better:

Staffing levels were not consistently being maintained to a level which ensure service users needs were met. This has been highlighted at the last inspection where an immediate requirement was issued to the Provider. The provision of activities to service users was limited and care plans did not record how service users social and leisure needs were to be met. The sample of recruitment files examined revealed that some required documents were missing, this included references and photographs. The Manager said the references had been received but they could not be located. There was an element of disorganisation in the office and some documents were no immediately available where they should and took a little time to locate. The water temperatures being recorded were low and in one bath tested at the visit the water was cold. There were not records in place where service users valuables were being kept safely. The accident records did not always correlate with the accidents recorded in service users care files. Some quality assurance processes were in place but these were limited and did not include any consultations with service users.

CARE HOMES FOR OLDER PEOPLE Rydal House Nursing Home 21 Somersall Lane Chesterfield Derbyshire S40 3LA Lead Inspector Bridgette Hill Key Unannounced Inspection 12th November 2007 09:25 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 Rydal House Nursing Home DS0000002073.V351985.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. Rydal House Nursing Home DS0000002073.V351985.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Rydal House Nursing Home Address 21 Somersall Lane Chesterfield Derbyshire S40 3LA 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) 01246 569511 Mr D Chand Dr. Anjuman Diwan Chand Mrs Maureen Brown Care Home 31 Category(ies) of Old age, not falling within any other category registration, with number (31) of places Rydal House Nursing Home DS0000002073.V351985.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 10th April 2007 Brief Description of the Service: Rydal House is situated on the western side of Chesterfield within a pleasant residential area, close to local amenities and within easy access of a main bus route. The home is a converted building, with an extension, set in its own grounds. It has separate lounges and dining rooms, on the ground floor. A conservatory has been added. The home has provision for nursing and personal care, and is registered to provide care for a maximum of 31 residents. Fees range from £333.85 - £498.30 extra charges are made for chiropody, hairdressing, newspapers and toiletries. This information was gathered at the inspection of the home. The latest inspection report and a Statement of Purpose was available in the office for service users or their representatives to see. Rydal House Nursing Home DS0000002073.V351985.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was an unannounced one. The purpose of this inspection was to assess all key standards and compliance to previously listed requirements. The Inspector was accompanied for part of the Inspection by an ‘Expert by experience’ Iris Wagstaffe MBE. An ‘expert by experience’ is a person who, because of their shared experience of using services, and/or ways of communicating, visits a service with an inspector to help them get a picture of what it is like to live in or use the service. The expert by experience spent time during the visit speaking to residents regarding the lifestyle of the home and ascertaining their views of the service. Various records including care planning records were examined the findings are recorded in the body of this report. Discussions were held with residents, relatives, staff and visiting professionals during the visit. Some service users had levels of confusion evident which affected their ability to convey their views. An Annual Quality Assurance Assessment was completed by the Manager of the home prior to the visit and where relevant the content has been included in the body of this report. The Manager Maureen Brown was on duty during the inspection. What the service does well: What has improved since the last inspection? There have been domestic and kitchen staff employed since the last inspection. There are however some issues evident around safe food handling and attention to detail with cleaning in the home. Rydal House Nursing Home DS0000002073.V351985.R01.S.doc Version 5.2 Page 6 There has been some floor replacement in 3 bedrooms. A new washer and dryer have been installed. Ongoing investment into curtain and furniture replacement is imminent in order to improve the environment. 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. The summary of this inspection report can be made available in other formats on request. Rydal House Nursing Home DS0000002073.V351985.R01.S.doc Version 5.2 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 Rydal House Nursing Home DS0000002073.V351985.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is some inconsistent practice in place to recording baseline assessments of service users which may mean service users needs may not be identified or met. EVIDENCE: The file of a recently admitted service user was examined. The admission had been an emergency one. Whilst some information had been sought from one healthcare professional the staff at the home had not completed a baseline assessment of the service user or documented all the identified needs. Other files examined indicated that the Free Nursing Care assessments were in place where service users received nursing care. The Manager said that where admissions were planned assessments prior to admission were completed and some examples were seen. Rydal House Nursing Home DS0000002073.V351985.R01.S.doc Version 5.2 Page 9 An information pack was available to new service users and the most recent inspection report was in the office but no information was given to service users that this was accessible to them. The home does not offer intermediate care as defined by National Minimum Standards 6. Rydal House Nursing Home DS0000002073.V351985.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The care plans in place are inconsistently written and lack sufficient detail to ensure service users needs will be met at all times. EVIDENCE: A sample of three service users care files were examined to assess how standards were being met. The care plans in place were found to be variable and frequently poor in detailing how staff were to meet service users needs. An example of this is a care plan which referred to the service user experiencing pain but no detail of where this was or what circumstances made this worse, if any. Care plans also did not detail where service users self medicated. Some interventions were recorded as giving care ‘as required’ which does not give sufficient instructions to staff on the service users abilities, preferences and needs. Rydal House Nursing Home DS0000002073.V351985.R01.S.doc Version 5.2 Page 11 There were also examples of where service users had some sensory impairment that would affect their abilities which were not included in the plan of care. Some problems were identified in assessments and log notes, which were not included in the care plan. None of the care plans seen had been signed by service users or their representatives. The Manager said that they were in the process of implementing a key worker system and in one bedroom a poster informed the service user who their key worker was. A range of risk assessment tools were being completed as part of the care planning process this included tissue viability, nutrition, There had been some reviews of risk assessment tools and care plans on a typically monthly basis. Daily log records were written for each shift worked by staff. These were found to be detailed and well written with attention to detail given such as specific amounts service users had eaten There was a generally disjointed approach to recording care with a range of separate records being kept in different files and books. This included social histories, weights, daily log records, care plans, dressing care plans and daily care sheets all kept separately which does not allow staff to have easy access to a full range of information about service users. There were records of GP’s, District nurses and other healthcare professionals visited service users. A chiropodist visited the home on a regular basis and a poster was displayed in the entrance hall although the dates displayed were not accurate. Arrangements were in place for service users to access dentists and opticians. The storage and administration of medicines was examined at this visit. There were systems in place to record what medications were received into the home and what medications were disposed of. There were no gaps on the medication administration records. Some of the medication administration records had photographs of service users to aid identification, others did not. Some service users did self medicate some of their medication. No risk assessments of service users abilities and consent were in place for this. In one bathroom a tub of unnamed or undated was open and being used. The Expert by Experience considered that service users all appeared clean and tidy with combed hair and the gentlemen shaven, were dressed in clean and pressed clothes. The Expert by Experience observed inter-actions observed between service users and staff where it was evident that the staff were well aware of and Rydal House Nursing Home DS0000002073.V351985.R01.S.doc Version 5.2 Page 12 responsive to individual needs; were kindly, respectful and mindful of dignity issues. There appeared to some flexibility in routines and service users spoken with who got up early said they able to have a cup of tea in their rooms. Rydal House Nursing Home DS0000002073.V351985.R01.S.doc Version 5.2 Page 13 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): 12,13,14,15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Some leisure and social are activities are offered however these have been variable in frequency and quality and there are insufficient consultations and records in place to evidence that these meet the service users needs. EVIDENCE: An expert by experience spent time at the inspection talking to service users and relatives to find out their views of the home. Some records relating to social and leisure needs were also assessed. An activities coordinator is employed at the home but has been off sick since August. One member of staff is working one afternoon to provide some activities. A hairdresser visits the home weekly. A list of planned of activities was placed on a notice board but the planned activity for the day of the visit did not take place. A diary of activities was kept. This indicated that there did appear to be less activities occurring since the activities coordinator has been off. Some of the activities recorded were Rydal House Nursing Home DS0000002073.V351985.R01.S.doc Version 5.2 Page 14 typically passive ones such as watching television or listening to music with no indication if staff facilitated these. Some service users had televisions in their bedroom and their own mobile phone, alternatively a portable payphone was available. Care records indicated that some service users did go out and spend time with their families. The Expert by Experience observed some service users following their own interests during the visit by watering plants, reading newspapers and doing puzzles and considered that there was little evidence from the home’s main notice boards of any structured activities in the home apart from listing the dates and times of services at the local church Other activities recorded included external entertainers, the church visited on a fortnightly basis, social talks, nails, games (dominoes, cards), jigsaws, books and exercises. The music played in the home was of a suitable style for the service users and was played with one individual in mind who particularly appeared to benefit from hearing their favourite singer. One service user spoken with told of a annual visit to a pantomime but no other outings appeared to be organised despite a mini bus being available. Some contact with relatives was recorded and some service users spent time out of the home with their relatives. The care plans viewed for service users did not contain any reference to service users social and leisure needs or how they were to be assessed. Some social histories for service users had been completed however these were in a separate file to the care planning documents. Some poor food handling and hygiene practices were observed in the kitchen. The teatime sandwiches had been made and left out if the fridge up to 3 hours before serving, meat was also left defrosting on the worktop when it should have been on the lowest level of the fridge. The kitchen floors were swept in the middle but the edges and under freestanding units were littered with crumbs and debris. Some of the cupboards also required cleaning out. The Expert by Experience ate lunch with service users and observed that appropriate cutlery was provided for those with special needs and that sizes of portions and sizes of plates matched known needs and that where assistance was required to cut food into smaller portions this was done unobtrusively The Expert by experience observed that no choice of menu was offered but service users confirmed that staff and the cook were all aware of individual Rydal House Nursing Home DS0000002073.V351985.R01.S.doc Version 5.2 Page 15 likes and dislikes. One service user had their own saltcellar as cruets were not routinely on tables although the Manager said they were available. The Expert by Experience was concerned that many of the frailer service user who needed one to one support to eat their food could not receive staff’s full attention as there seemed to be only 2 care staff available plus the assistant cook who had had the sole responsibility for cooking the meal but who also assisted the frailer residents. Staff seemed constantly moving around trying to ensure help for those who had problems feeding themselves. Relatives spoken with said the cook was “brilliant” providing birthday cakes for each resident’s birthday. Photographs of birthday celebrations were displayed in the entrance hallway. Rydal House Nursing Home DS0000002073.V351985.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): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Complaints received have been handled appropriately and staff are trained in Safeguarding Adults and have access to policies which will ensure service users are listened to and actions are taken. EVIDENCE: The Annual Quality Assurance Assessment received by Commission for Social Care Inspection recorded that 3 complaints had been received at the home in the past 12 months. One of these had been received since the last inspection. The details of this were examined. The Commission for Social Care Inspection had received no complaints since the last inspection on 10th April 2007. The complaint received since the last inspection related to poor carpets in bedrooms. Social Services Contracting Department visited the home and also communicated by letter regarding the concern. It was recorded that action had been taken to address the concerns and in 3 bedrooms the flooring had been replaced with non-slip linoleum type flooring. Discussions were held with the Manager regarding the recording of complaints that were said to be in a book in the reception hallway. The recording of concerns in a book doesn’t ensure confidentiality or privacy of service users is Rydal House Nursing Home DS0000002073.V351985.R01.S.doc Version 5.2 Page 17 protected and may deter service users or relatives from complaining if they do not wish their concerns to be openly accessible to others. Some information on notice boards was out of date such as the address of the Commission for Social care Inspection and notices where the NCSC was referred to. There have not been any investigations relating to safeguarding adult concerns since the last inspection. Training records and discussions with staff indicated that staff had received training in Safeguarding Adults. A policy and procedure was available which was not wholly clear as to the process to be followed as it advocated internal investigation and referral through Social Services Safeguarding Adults procedures. A whistle blowing policy was also available for staff to advise what to do if they had concerns. Rydal House Nursing Home DS0000002073.V351985.R01.S.doc Version 5.2 Page 18 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): 19,26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is some ongoing maintenance and investment in the home however some aspects continue to require upgrading to ensure the home is a comfortable one for service users to live in. EVIDENCE: The home is a converted residential property that has been extended to provide care home accommodation. The home has two floors with a passenger lift to allow access to both floors to those with mobility problems. The residents seemed split between 2 lounge and dining areas and there was a conservatory area. Rydal House Nursing Home DS0000002073.V351985.R01.S.doc Version 5.2 Page 19 The home has flat gardens accessed through several doors including the large conservatory at the rear of the home which had a ramped pathway to patio areas that lead on to lawns. Residents confirmed they could and did use the patios, which did have tables and chairs, and garden areas in the summer and during fine weather. Some redecoration of corridors was underway. The curtains in some areas were also not in place as new ones were on order and due soon. Lounge and dining chairs were also on order. Some chairs seen had significant signs of use and wear and were in need of replacement. A sample of bedrooms were viewed at this visit. Bedrooms were found to be personalised with service users belongings. Safety locks were fitted on bedroom doors and one service user held the key to their room. Some bedrooms had lockable storage for service users to use others did not. Some of the bed linen being used was faded. Some of the bedroom furniture was also dated and not wholly domestic in character as some old style hospital lockers were being used. The Manager said that only two of the bathrooms were in regular use. One bath was piled high with a range of items; this did not allow easy access to run the water to prevent legionella. The water temperatures in bathrooms and bedrooms were being recorded. The records indicated that a sample area was completed weekly. As only a sample was competed some baths and showers had not been checked since June 2007. Many of the temperatures recorded indicated that the water temperatures were typically 38 – 40 °c (should be 43 ° c or – 2 ° c). One bath did not have any hot water available at all. There were domestic staff employed for 24 hours per week. The home had areas where it was slightly untidy and there was poor attention to detail in some standards of cleanliness in the home. Staff had easy access to gloves and aprons. Liquid soap and paper towels were in bathroom and toilet areas. The laundry area was not lockable and had detergents openly stored in it. There had been a new washer and dryer fitted since the last inspection. Service users spoken with said they were happy with the laundry service they received. A sluicing disinfector is available in one sluice area. One service user told the Expert by Experience that the laundry lady “got their clothes up lovely” although one or two others said that relatives laundered anything that was particularly special. Rydal House Nursing Home DS0000002073.V351985.R01.S.doc Version 5.2 Page 20 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): 27,28,29,30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Whilst staff are well trained, caring and positively regarded the levels of care staff at the home were insufficient to ensure that service users needs would be met. EVIDENCE: The occupancy of the home on the day of the visit was 21 service users. 8 service users required nursing care, 13 service users required personal care only. The typical staffing levels at the home which were aimed for were 1 nurse on duty for all shifts with 3 care staff for morning shifts, 3 care staff in the afternoons. At nights there was one qualified nurse and1 care staff. The rota’s examined indicated that for some shifts including the day of the visit only 2 care staff were on duty. The Manager explained that the morning deficit was due to staff not able to work at short notice. For the afternoon shift however only 2 care staff were planned to be on duty. For example the 13th & 14th November 2007 only 2 care staff plus one nurse were planned to be on duty. Some agency staff were being used for night shifts. The manager said the shortage in staffing had been caused by staff leaving and recruitment was underway to fill vacancies. Rydal House Nursing Home DS0000002073.V351985.R01.S.doc Version 5.2 Page 21 Staff spoken to said that levels of staff were low on occasions. The environment of the home had a number of lounges and dining rooms, which were used by service users, and also there were 2 service users who were cared for in bed at the time of the visit. This placed limitations on the level of care and observation staff could deliver. Some service users also required 2 staff as they needed to use the hoist to move and 5 service users required help to eat. The Expert by Experience spoke with relatives who were concerned about the low staffing levels which they felt were significantly lower than when their relative was admitted to the home and said the home “clearly could do better” in this respect. They said there had been times when they visited that they had found their relative obviously required her personal needs addressing. Nevertheless, they felt that staff were doing their very best to care for highly dependent older people and that as they and their other relatives visited several times a week they were able to keep a close eye on the care provided. Another relative spoken with was also full of praise for the care given and said it had afforded ‘peace of mind’ to her and her husband their relative was safe and secure It is an outstanding requirement from the last inspection that care staff levels must be increased to ensure service users needs are met. Other staff employed at the home was a handyman who was shared with a sister home, domestic staff and kitchen staff. Training records at the home indicated that there were 13 care staff employed at the home of which 9 held at least NVQ (National Vocational Qualification) level 2 in care qualifications with 3 of these having achieved National Vocational Qualification level 3. A sample of three staff files was examined to assess how recruitment procedures were being followed. These indicated that there was not documentary proof that all required checks had been competed prior to staff commencing employment at the home. The deficits included no references being in place and photographs of staff not being available. Typically staff commenced work with a Pova first check being obtained whilst a full Criminal records Bureau check was being processed. A sample of the staff training files was examined. Certificates of completed training were available in staff files and an overview of what staff training had taken place was available. A range of training had been completed and all mandatory training was up to date. Staff training had been competed in First Aid, Safeguarding Adults, fire safety, activities and dementia, basic food Rydal House Nursing Home DS0000002073.V351985.R01.S.doc Version 5.2 Page 22 hygiene, continence and Moving and handling. Typically external training agencies were used to provide the training. A skill based induction pack was available and the Manager said some new staff had been issued with the books but no completed examples were seen. Rydal House Nursing Home DS0000002073.V351985.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The Manager has minimal time to dedicate to ensuring the home is staffed sufficiently, that quality assurance systems are implemented and that the there is a consistent approach in planning and delivering of care which may adversely affect service users. EVIDENCE: The Manager of the home had worked at the home for approximately 9 years. For many shifts worked by the Manager they were the only nurse on duty and had limited time to undertake managerial tasks. The staffing levels at the home were not being consistently maintained and generally consensus from Rydal House Nursing Home DS0000002073.V351985.R01.S.doc Version 5.2 Page 24 relatives, service users and staff was that they were not sufficient. This was supported by some observations of care during the visit. Staff spoken with said they regarded the Manager as approachable and caring. Relatives and service users spoken with also positively regarded the Manager and their warm approach to service users. The quality assurance processes in place were examined. The Provider had completed monthly monitoring visits of the home. These documented some checks of records but did not include any discussions with service users or staff. Some staff meetings were documented on an approximately 2-monthly basis but the detailing of these were brief. Some service user surveys had been undertaken in previous years but none had been done in the past year. No service user or relative meetings were held and the only opportunity for views to be conveyed was on an informal level and there was no recording of this. Small amounts of service users monies were stored safely on behalf of service users. This was typically used to pay the hairdresser and chiropodist. Three balances were checked against the monies available, 2 were accurate, 1 was found to have more money by 40p than the record indicated. Some service users items of value were found to be stored in the drug cupboard. There was not an inventory of what had been accepted for safekeeping so it would not have been possible to establish if anything was missing. The service records for electrical installations, gas, lift and checks for legionella bacteria were all in date. An accident book was available and some recent entries had been recorded however an accident was recorded in a service users care file for which no form had been competed. The policy relating to accidents stated that accident audits should be completed but the Manager said that these were not undertaken. Rydal House Nursing Home DS0000002073.V351985.R01.S.doc Version 5.2 Page 25 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 2 x x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x x x 2 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 2 x 2 x x 2 Rydal House Nursing Home DS0000002073.V351985.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15 Requirement Personalised care plans must be in for each service user which informs staff of service users needs are to be met Topical preparations must be appropriately stored, dated on opening and used only for the service user for whom they are prescribed Where service users self medicate there must be documented risk assessments, suitable storage arrangements and consent form in place The registered person must ensure that activities and therapy are available to meet the needs of the service user’s social, cultural, religious and recreational interests. Previous timescale 31/05/07 5 6 OP15 OP27 23 18(1)(a) There must be safe food handling practice and hygiene practices There must be sufficient care staff on duty at the home at all times to meet the needs of DS0000002073.V351985.R01.S.doc Timescale for action 15/12/07 2 OP9 13(2) 30/11/07 3 OP9 13(2) 15/12/07 4 OP12 16 (2) (m) 31/12/07 30/11/07 30/11/07 Rydal House Nursing Home Version 5.2 Page 27 residents and levels of staffing must be maintained at the previously agreed levels as a minimum. 7 OP29 19 Schedule 2 Previous timescale 31/05/07 The provider must ensure staff do not commence employment until all required checks and documentation are satisfactorily in place as detailed in Regulation 19 and Schedule 2 The provider must ensure there is recorded monitoring of water temperatures where full body immersion is possible and that the temperatures are within 43º or - 2 degrees Where accidents occur these must be recorded on an appropriate accident form 30/11/07 8 OP38 13 30/11/07 9 OP38 17 Schedule 3, 3(j) 30/11/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP2 OP7 Good Practice Recommendations Service users and their representatives should be given easy access to the inspection report Residents should be actively consulted about their written care plans, which should be drawn up with the involvement of the resident, be accessible to them and be agreed and signed by them as capable or their representative. The disjointed approach to recording care and storing information should be reviewed to improve access of information to staff There should be a review of how complaints are recorded to ensure service users privacy and confidentiality are maintained 3 4 OP7 OP16 Rydal House Nursing Home DS0000002073.V351985.R01.S.doc Version 5.2 Page 28 5 OP18 Information on the complaints display relating to the Commission for Social care Inspection address should be updated The safe guarding adult procedure should be explicit in describing at what stage there is referral to locally agreed multi agency procedures The Fire Risk Assessment should be reviewed to ensure it is meets currents regulations Work should be undertaken to improve the quality assurance processes in place to ensure there is consistency in all areas of the administration of the h0ome and service users are consulted regarding the service Balance checks of service users monies should be routinely undertaken A system should be implemented to record where valuables are being stored safely on service users behalf 6 7 OP19 OP33 8 OP35 Rydal House Nursing Home DS0000002073.V351985.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT 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. 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