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Inspection on 27/10/05 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 27th October 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 relatives and service users expressed their satisfaction of the delivery of care.

What has improved since the last inspection?

The rooms, except for one, have been redecorated. The carpet cleaned. The freezers contained more food than at the previous inspection.

What the care home could do better:

There is a limited amount of activities and these needs to be increased to meet the needs of the service users. The manager and registered person need to manage and run the home and ensure that the registered person and company complies with the requirements which include, the expected recruitment practice, providetraining for the staff, formal supervision, and quality monitoring, including Regulation 26 visits by the registered person.

CARE HOMES FOR OLDER PEOPLE Rydal House Nursing Home 21 Somersall Lane Chesterfield Derbyshire S40 3LA Lead Inspector Ivan Barker Unannounced Inspection 27th October 2005 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Rydal House Nursing Home DS0000002073.V262004.R01.S.doc Version 5.0 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.V262004.R01.S.doc Version 5.0 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.V262004.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th June 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.V262004.R01.S.doc Version 5.0 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 several of the ‘key standards’). However, even from examination of prioritised standards, a number of requirements have been raised as a result of the findings on the day of this visit to the care home. The person present at the inspection was: Mrs M Brown, manager. Within this inspection, which occurred over a 3-hour period, the inspector toured the building, spoke with relatives, service users and some staff and examined some documentation. The registered persons are failing to provide a service that meets many of the key National Minimum Standards. Therefore it has been agreed with the manager that there will be substantial improvement and the requirements met with the next month. Therefore there will be an escalating level of monitoring by the Commission for Social Care Inspection and a further inspection will occur in approximately one month. None compliance at this stage may result in enforcement action, by the Commission for Social Care Inspection. What the service does well: What has improved since the last inspection? What they could do better: There is a limited amount of activities and these needs to be increased to meet the needs of the service users. The manager and registered person need to manage and run the home and ensure that the registered person and company complies with the requirements which include, the expected recruitment practice, provide Rydal House Nursing Home DS0000002073.V262004.R01.S.doc Version 5.0 Page 6 training for the staff, formal supervision, and quality monitoring, including Regulation 26 visits by the registered person. 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.V262004.R01.S.doc Version 5.0 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.V262004.R01.S.doc Version 5.0 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): Standard 3 Accurate assessments will ensure that the home has sufficient information to be aware of the service user’s needs prior to admission. EVIDENCE: The home received service user assessments from the Social Services Care managers or the hospital prior to admission. The manager or senior staff prior to admission to the home assessed all service users. The manager informed the inspector that emergency admissions did not occur. Rydal House Nursing Home DS0000002073.V262004.R01.S.doc Version 5.0 Page 9 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 9, 10. The system for the administration of the medicine, observed at the time of inspection was operating correctly. Service users were able to exercise their rights of choice and to privacy and dignity, as far as issues monitored by the inspector. EVIDENCE: The administration and storage system for medications was satisfactory. The medication was provided from the Boots pharmacy and the Boots system of dispensing. The manager informed the inspector that she was still in discussion with Boots regarding the disposal of medications. At present the home was stocking piling the drugs. However the manager advised the inspector that Boots were to visit the home tomorrow, as part of their auditing process, and disposal of the drugs would be discussed at the visit. Through observation and discussions with managers and staff it was established that Standard 10 was being met. Rydal House Nursing Home DS0000002073.V262004.R01.S.doc Version 5.0 Page 10 Service users were able to wear their own clothes and to make a choice of the items to wear each morning. Service users were addressed by their preferred name. Members of staff were observed to knock on the bedroom doors before entering. Visitors were allowed to visit the service user in the communal areas or in the privacy of their own room. The inspector obtained the views of 4 relatives and 6 service users. All the persons who spoke with the inspector identified that they were satisfied with the standard of care and the inspector received commendations on how helpful and friendly the staff were towards them. Rydal House Nursing Home DS0000002073.V262004.R01.S.doc Version 5.0 Page 11 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. There was little evidence that service users receive therapy and stimulation through activities or recreation. The inspector recognised that to encourage and stimulate service users to participate in activities can be a difficult challenge, and that the service user has a right to refuse to participate. However if only minimal activities and stimulation are provided then apathy soon develops, which who appear to be the case from the comments that were received from the service users. EVIDENCE: The inspector did not observe any organised activity during the inspection. No activities programme was displayed. Televisions were switched on within the lounge areas. Some of the service users, who had significant levels of confusion, were wandering the building. The manager informed the inspector that there was a specific person employed to undertake activities, within the home. This person was also employed to undertake kitchen and care duties, during her shift. Each one of her duties (activities, kitchen, or care) had a specific time period. The ‘activities period’ was planned for later in the day. Rydal House Nursing Home DS0000002073.V262004.R01.S.doc Version 5.0 Page 12 The inspector discussed with the service users the provision of activities. Several service users informed him that ‘they were not bothered with activities’. One service user informed the inspector that she was quite happy reading her books. The manager informed the inspector that entertainers visited the home and outing did occur. On monitoring the previous requirements the inspector observed that a menu was displayed. The 2 freezers contained more food than at the previous inspection. The cook since the last inspection had commenced recording the number of service users who requested the first or second choice of meal. Rydal House Nursing Home DS0000002073.V262004.R01.S.doc Version 5.0 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): Standards 16, 18 As far as could be established the home took complaints seriously and acted upon the issues, although there was no evidence of any complaints. The staff did not receive training, which would make them aware of Adult Protection. EVIDENCE: The complaints procedure was displayed, and contained the necessary information. The manager informed the inspector that she had not received any complaints. No one during the inspection raised any complaints with the inspector during his discussions with the relatives and service users. On discussing the training of staff regarding the Protection of Vulnerable Adults, the manager informed the inspector that she was having difficulty accessing such training, and therefore staff had not attended training in Adult Protection. The inspector advised the manager that she should contact Mr A Hamilton Adult Protection Co-ordinator for the Derbyshire Social Services regarding Adult Protection training. Rydal House Nursing Home DS0000002073.V262004.R01.S.doc Version 5.0 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): Compliance to the environment had been achieved, except for the decoration of one room. EVIDENCE: These standards were not assessed except for the previous requirements. Rooms 8,16 and 23 had received attention to the decoration. Room 27 still required attention. Therefore the requirement was repeated. The carpet in Room 29 had received extensive shampooing and at the time of the inspection the room was odour free. Rooms 23 and 25 had window restrictors in place. The storage cupboard, which contained chemicals, was locked. Rydal House Nursing Home DS0000002073.V262004.R01.S.doc Version 5.0 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): Standards 29, 30 The records examined showed that appropriate checks had not been carried out and potentially leaves service users at risk. The delivery of care may be compromised due to insufficiently trained staff and the lack of equipment. EVIDENCE: When the inspector sampled the staff records last year he found that the ones sampled contained the required information. However on sampling 3 staff files on this inspection the inspector found that: The photographs available last year had been removed. A member of staff had been employed in January 2005, with a Criminal records bureau check dated March 2003, from a previous employer. A new CRB check should have been undertaken. One file contained only one reference and another file contained none. The inspector discussed the omissions with the manager regarding employing staff without adequate references and CRB check. The manager informed the inspector that she would refer to Schedule 2 and 4 of the Care Standards Act, and ensure that the files contained the expected documentation. The inspector highlighted the fact that at present the manager was providing ‘hands on’ care Rydal House Nursing Home DS0000002073.V262004.R01.S.doc Version 5.0 Page 16 provision, and questioned what time she had available for administration work. The manager assured the inspector that the work would be completed. On examination of the training records the inspector could not establish when moving and handling and fire training had occurred. On discussing this fact with the manager, she informed the inspector that both were out of date, except for issues of moving and handling that might have been covered within the NVQ training, for staff who were undertaking this course. She then explained that Fire and Moving and handling training were ‘booked in’ for November. On discussing training with the staff, they informed the inspector that: They had not received any instruction and new staff had only watched a video, and that their training was out of date. Through these discussion the inspector was informed that: The home now had only one mobile hoist for both floors of the home, and staff and service users had to wait for the appliance ‘to be available’. During busy periods i.e. in the morning as service users were getting up, was creating problems. Therefore as the one hoist, was not available members of staff were manual lifting service users, in the absence of the hoist. Clearly this practice, and the lack of training for the staff will place the service users and staff at considerable risk of injury. On returning to the office the inspector questioned the manager over the lack of hoisting facilities. She informed the inspector that one hoist had broken and that staff had to use the mobile hoist, by transporting it via the lift, between the two floors. However she was looking to purchase another hoist, but would need the authorisation from the registered person. Rydal House Nursing Home DS0000002073.V262004.R01.S.doc Version 5.0 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): Standard 31, 33, 35, 36,38. The manager and registered person need to examine the management and running of the home, as at the moment it lacks leadership for a management prospective. EVIDENCE: On examination of the staff rota, the inspector established that the home was operating on minimal qualified nurse cover, with the manager and one member of staff being the permanent employees. The other qualified members of staff were employed in other establishments, i.e. other care homes or the NHS, and were providing ad hoc cover. The manager had arranged for 2 days supernumerary days, on future rotas, however on examination of previous duty rotas, these days had been changed to providing ‘hands on care’, as the other qualified ad hoc members of staff were unavailable. Rydal House Nursing Home DS0000002073.V262004.R01.S.doc Version 5.0 Page 18 On raising the issue of staff supervision the manager informed the inspector that she had started the supervision, but not continued it as she had been busy providing ‘hands on’ care. When discussing the quality monitoring systems which she had commence at the last inspection the manager identified that the last auditing was the one that the inspector had seen in September 2004, but she had undertaken a satisfaction questionnaire in September 2005. The inspector requested to see the accounting system for the service users monies being held by the home. The manager informed the inspector that the records were at her home, and unavailable for inspection. The inspector then asked what would happen if a service user required some money. The manager explained that the service user would be given the money and the recording done at a later date. On requesting to see the documentation regarding the registered person’s Regulation 26 visits, the manager informed the inspector that there were no records available. However Mr and Mrs Chand did visit the home on a frequent basis. Following the managers inability to provide evidence as requested above, she agreed with the inspector that she was providing ‘hands on’ care and did not have sufficient time or support to attend to managerial issues. This was evidenced by the lack of documentation within the staff files, of formal supervision and training of staff, and of quality assurance system including the omission of registered person’s regulation 26 visits. However she went on to explain that in her opinion the care delivered by her and her staff was of good quality. The health and safety shortfalls are listed within previous section of this report. Rydal House Nursing Home DS0000002073.V262004.R01.S.doc Version 5.0 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 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 X X X X X X X 2 STAFFING Standard No Score 27 X 28 X 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X 1 2 X 1 Rydal House Nursing Home DS0000002073.V262004.R01.S.doc Version 5.0 Page 20 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 OP12 Regulation 12 Requirement 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. The registered person must ensure that all staff receive training in Adult Protection. The registered person must ensure that the service users live in a safe, clean, pleasant, well maintained environment. Therefore room 27 requires attention as listed in the body of the report. The registered person must ensure that accurate staff files are kept which contain the information required in Schedule 2 and 4. The registered person must ensure that all staff receive training in Fire and Moving and Handling. The registered person must ensure that the home has the quality assurance monitoring by the registered person and DS0000002073.V262004.R01.S.doc Timescale for action 27/11/05 2 3 OP18 OP26 18 16 27/11/05 27/11/05 4 OP29 18, 19 27/11/05 5 OP30 18 27/11/05 6 OP33 26 27/11/05 Rydal House Nursing Home Version 5.0 Page 21 7 OP31 9, 18 8 OP33 24 9 10 OP36 OP38 18 12, 13 records such monitoring by the provision of a Regulation 26 document. The registered person must ensure that the manager is able to discharge her managerial responsibilities fully. The registered person must ensure that the home has a quality assurance monitoring system with a systematic cycle. The registered person must ensure that formal supervision occurs at least six times a year. The registered person must ensure the adequate provision of equipment (hoist) to meet the needs of service users and to reduce the possible injury to staff. 27/11/05 27/11/05 27/11/05 27/11/05 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.V262004.R01.S.doc Version 5.0 Page 22 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.V262004.R01.S.doc Version 5.0 Page 23 - 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!