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Inspection on 26/04/06 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 26th April 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

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 inspector received positive comments and commendations from the service users regarding the standard of care and service provision.

What has improved since the last inspection?

Since the inspection on the 27th October 2005 and an addition inspection visit on the 5th December 2005, there has now been full compliance to the requirements made at these inspections. The inspector recognised the effort that the registered person and manager had made to achieve the compliance. The manager now has supernumerary time to organise and manage the home, rather than provide 100% `hands on care`. The benefits of this, is that activities have developed, the staff have received supervision, and also training in Adult Protection, Fire and Moving and Handling, the shortfalls in staff records have received attention, regulation 26 visits now occur and are recorded, and quality monitoring by the manager has occurred.

What the care home could do better:

The assessment documentation was completed, but the date of the assessment and the signature was not apparent. Therefore better record keeping is necessary. A fire exit was blocked at the time of the inspection, and minor repairs are needed to one room and a bedroom lock. Better safe guards on the administration and storage of monies needs to occur.

CARE HOMES FOR OLDER PEOPLE Rydal House Nursing Home 21 Somersall Lane Chesterfield Derbyshire S40 3LA Lead Inspector Ivan Barker Unannounced Inspection 26th April 2006 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 Rydal House Nursing Home DS0000002073.V290347.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. Rydal House Nursing Home DS0000002073.V290347.R01.S.doc Version 5.1 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.V290347.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 27th October 2005 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. Rydal House Nursing Home DS0000002073.V290347.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Only a limited number of the National Minimum Standards were examined at this inspection (with emphasis on the ‘key standards’), and the previous requirements. The person present at the inspection was: Mrs M Brown, registered manager. Within this inspection, which occurred over a four-hour period, the inspector toured the building, examined requirements relating to the previous inspection, spoke with service users, and staff and examined some documentation, using case tracking as the methodology. What the service does well: What has improved since the last inspection? What they could do better: The assessment documentation was completed, but the date of the assessment and the signature was not apparent. Therefore better record keeping is necessary. A fire exit was blocked at the time of the inspection, and minor repairs are needed to one room and a bedroom lock. Better safe guards on the administration and storage of monies needs to occur. Rydal House Nursing Home DS0000002073.V290347.R01.S.doc Version 5.1 Page 6 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. Rydal House Nursing Home DS0000002073.V290347.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 Rydal House Nursing Home DS0000002073.V290347.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): Standards 3, 6. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. The manager was unable to provide evidence that assessments were obtained prior to admission, therefore service users may be admitted without the home being able to meet the service users needs. EVIDENCE: The obtaining of assessments, prior to admission will ensure that the home had sufficient information to be aware of the service user’s needs and a decision could be made, if these needs could be met. The manager advised the inspector that she undertook an assessment of the service user, prior to admission. However on examination of the documentation the assessment and admission docs were on the same form. There were no dates or signatures on the document that would indicate that the assessment was undertaken prior to the admission. As part of the case tracking process the inspector spoke with the service users. A service user confirmed that the manager had visited her prior to the admission. Rydal House Nursing Home DS0000002073.V290347.R01.S.doc Version 5.1 Page 9 The home obtained the assessments, prior to admission from Care managers and Nursing staff from the hospitals. These assessments provided the basis for the completion of the care plans, which contained the assessments detailed in Standard 3. The manager advised the inspector that the home did not admit service users requiring intermediate care. Rydal House Nursing Home DS0000002073.V290347.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): Standards 7,8,9,10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Accurate care plans and the staff being aware of the service user’s care needs will contribute to the delivery of care. The system for the administration of the medication was adequate. There was a secure environment for the medications. There were no omission within the medication administration records and these factors will contribute to the medications being administered in the correct manner. EVIDENCE: On examination of the two care plans of the two service users who were being case tracked, the plans were drawn up using information from the assessment and admission document. The inspector found that both care plans had been re-evaluated on a monthly basis. Risk assessment were included within the documentation and included moving and handling and pressure area risk assessments. Rydal House Nursing Home DS0000002073.V290347.R01.S.doc Version 5.1 Page 11 The inspector spoke with the two service users who were being case tracked. One service user was only able to answer the inspector questions by a response of ‘yes or no’. However the inspector was able to establish that she was happy with her care and the standard of food. Also that she did not wish to participate in activities within the home, because of her frail condition. The other service user was a very articulated lady able to express her views. She identified that: ‘The home was a very friendly, homely place’. ‘The care was good’ ‘Able to retire and get up when I wish.’ ‘Good atmosphere for a laugh and a joke.’ The inspector had a discussion with 3 members of staff regarding the service users’ care needs. All 3 were aware of their needs. On examination of the storage, administration and disposal of medication the inspector found that the home was using the Boots system of storage and administration. The medication records were up to date, with no omissions in the record keeping. Any medication entries, which were hand-written, had a signature. The service users, who were receiving personal and nursing care, had their medication administered by the qualified nurse. Rydal House Nursing Home DS0000002073.V290347.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): Standards 12,13,14,15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. There were choices of meals, activities and other interactions, which should enhance the service users quality of life. EVIDENCE: The home employed an activities co-ordinator, 10 hours per week. (2 hours each day for 5 days). Care staff undertook the activities role on the remaining two days. There was a daily activity programme displayed on a notice board. The board also displayed information regarding entertainers who were to visit the home. One service user who was being case tracked informed the inspector that ‘Activities were organised and consisted of jigsaws and ‘slower things’.’ The manager advised the inspector that service users were allowed visitors to visit in either the communal lounge, or their bedroom. The inspector was able to establish that the service users had a choice of meal. The manager informed the inspector that after breakfast, the cook asked each service user what was their choice for the main meal of the day. Rydal House Nursing Home DS0000002073.V290347.R01.S.doc Version 5.1 Page 13 One service user who was being case tracked informed the inspector that ‘There was a choice of meals and if you didn’t like it when it was presented, they would change it for you’. At a previous inspection the inspector had established that the freezers were low on frozen food. The freezers were both half full, at this inspection. Rydal House Nursing Home DS0000002073.V290347.R01.S.doc Version 5.1 Page 14 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): Standards 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. As far as could be established the home had a complaints procedure in place, but evidence was not available how effective the procedure was, as there was no record of recent complaints. EVIDENCE: The complaints procedure was displayed and available to the service users and relatives. On discussing complaints with the service users, they informed the inspector that they were ‘happy’ with their care. No complaints were addressed to the inspector, at the time of this visit. On examination of the complaints book, there were no complaints recorded within the book. The Commission had received no complaints since the last inspection. Regarding Adult Protection training, the manager was able to evidence that since the last inspection, the staff had attended training. Therefore the previous requirement had been met. Rydal House Nursing Home DS0000002073.V290347.R01.S.doc Version 5.1 Page 15 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): Standards 19, 26. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. The environment, monitored at this inspection, had not been maintained to the required standard to provide a safe, well-maintained environment for services users. The service users, visitors and staff would be at risk, should there be a need to evacuate the home, and the fire exit be blocked by the parked cars. EVIDENCE: The home is a converted large house, which has indications of the age of the property and looks tired in some areas. However the general layout of the rooms creates a homely appearance, which plays some part in creating a homely atmosphere. The inspector was aware that this fact was important to the owners, the manager and the service users. The home was also clean and generally odour free. Rydal House Nursing Home DS0000002073.V290347.R01.S.doc Version 5.1 Page 16 On touring the building the following shortfalls were found. The fire exit on the ground floor had a parked car blocking the means of escape. It was established that the car belonged to a member of staff. The member of staff removed the car, and the manager agreed to raise the issue of not parking in front of the fire escape with staff, visitors etc. The bedroom lock on Room 3 had broken, and required repair or replacing. Room 16 had damage to the plaster and décor on the wall. The manager advised the inspector that a wheelchair had caused the damage. Rydal House Nursing Home DS0000002073.V290347.R01.S.doc Version 5.1 Page 17 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): Standards 27,28,29, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The necessary documentation designed to protect the service users were in the staff files. Staff had received moving and handling, fire and other training. A trained, up to date workforce will contribute to the delivery of care. EVIDENCE: The inspector examined the staff rotas and established the following: Am. 1 qualified nurse, and 3 care staff Pm. 1 qualified nurse, and 3 care staff N. 1 qualified nurse, and 2 care staff. The qualified nurse numbers included the manager of the home, except on two shifts per week when there was a qualified nurse and the manager had supernumerary management time. The occupancy at the time of inspection was 24 service users. One service user who was being case tracked informed the inspector that ‘Staff are very responsive to the bell at night, when I ring, they come.’ Rydal House Nursing Home DS0000002073.V290347.R01.S.doc Version 5.1 Page 18 On examination of the staff training records, the evidence that was presented to the inspector indicated that all staff training was up to date. At the previous inspection it was agreed that the manager would be able to evidence that the staff training had been organised for 2006/07. The manager provided evidence that she had consulted with trainers and obtained quotes, but the training was yet to be confirmed. The manager advised the inspector that she was prepared to write and inform the inspector of the training days when the dates had been booked. The inspector accepted this offer. Regarding NVQ training, the manager provided evidence that 7 staff had obtained their NVQ level 2, and 1 staff had obtained NVQ level 3. She went onto explain that 5 staff planned to start the NVQ level 2 and 4 staff planned to start their level 3. On discussing the training with the staff, the inspector was informed that, ‘the training had increased significantly this year’. There was a previous requirement to have accurate staff files, which contained the necessary information. On examination of the staff files at this inspection, those sampled contained all the required information. On the equality and diversity of the service, the inspector established that 4 qualified nurses from overseas were from the continent of Africa. 1 qualified nurse from overseas was from the continent of India. The service users were all of white British origin. Rydal House Nursing Home DS0000002073.V290347.R01.S.doc Version 5.1 Page 19 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): Standards 31, 33, 35, 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. There had been improvement in the organisational management of the home. This should provide the home with more direction and purpose, as improvement to the management will contribute to improvement in the quality of staff, service and care provision. However the system for handling service user monies may place the manager and service user’s monies at risk. EVIDENCE: At the previous inspection, it was established that the manager had been providing ‘hands on care’, as the other qualified members of staff were unavailable. This had resulted in a reduction in her management role, and this action had affected the management of the home. Rydal House Nursing Home DS0000002073.V290347.R01.S.doc Version 5.1 Page 20 On examination of the staff rotas it was established that qualified nurse cover had been provided to enable the manager to have 2 days supernumerary in her managerial role. Regarding quality assurance, the manager was able to provide evidence that some monitoring did occur. The staff and visitor’s questionnaires dated January and April 06 respectively indicated positive comments. A health and safety audit had been undertaken in January 06. Regulation 26 visits by the registered person did now occur and the inspector was able to examine the Regulation 26 documents, which the registered person had provided. On requesting to examine the accounting systems of the monies held on behalf of service users, the manager explained that she used the ‘envelope system’ to store the monies, but the balances in one envelope would be incorrect. She advised the manager that she had taken the money for ‘all the service users who had the hairdresser’. The manager reconciled the money by replacing the ‘owed’ money, from her own purse. The manager advised the inspector that she alone was responsible for the service users monies, as no administrator was employed. This practice could place the manager and service users monies at risk, as the good safe practice is to have two persons monitoring the monies, to limit the possibility of financial abuse. The manager agreed to review the practice. A debit and credit system was operated within the home for some service users. Regarding the previous requirement that the registered person must provide adequate equipment, a new hoist had been purchased. Rydal House Nursing Home DS0000002073.V290347.R01.S.doc Version 5.1 Page 21 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 N/A X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 2 X X 2 Rydal House Nursing Home DS0000002073.V290347.R01.S.doc Version 5.1 Page 22 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP3 Regulation 14 Requirement Timescale for action 26/05/06 2. OP19 16 3. OP35 12 and 16 4. OP38 12 and 16 The registered person must provided evidence that assessments occurred prior to the admission to ensure that the home is able to met the service users needs. The registered person must 26/05/06 ensure that the service users live in a safe, well-maintained environment. Therefore fire exits must be available as a means of escape and repairs undertaken as specified in the environment section of the report. The registered person must 26/05/06 ensure that the welfare of the service users is protected, by the provision of accurate accounting systems and records regarding service users monies. The registered person must 26/05/06 ensure that the welfare of the service users is protected, by the provision of accurate accounting systems and records regarding service users monies. Rydal House Nursing Home DS0000002073.V290347.R01.S.doc Version 5.1 Page 23 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Rydal House Nursing Home DS0000002073.V290347.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT National Enquiry Line: 0845 015 0120 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 Rydal House Nursing Home DS0000002073.V290347.R01.S.doc Version 5.1 Page 25 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!