CARE HOMES FOR OLDER PEOPLE
Rydal Road Care Home Rydal Road Darlington Durham DL1 4BH Lead Inspector
Bridgit Stockton Unannounced Inspection 9th December 2005 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 Road Care Home DS0000000746.V267550.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 Road Care Home DS0000000746.V267550.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Rydal Road Care Home Address Rydal Road Darlington Durham DL1 4BH 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) 01325 369329 01325 369339 Tamaris Healthcare (England) Ltd (wholly owned subsidiary of Four Seasons Health Care Limited) Mrs Lynn Clark Care Home 60 Category(ies) of Dementia - over 65 years of age (38), Old age, registration, with number not falling within any other category (22), of places Physical disability (6), Terminally ill (4) Rydal Road Care Home DS0000000746.V267550.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection Brief Description of the Service: Rydal Road Care Home is situated on the outskirts of Darlington town centre and is within easy reach of shops, leisure facilities and a local park. Frequent bus services operate within a short walking distance of the home. The home is divided into two separate units. The general unit provides nursing and residential care for older people, and the second unit provides 24 hour nursing care for older people suffering from dementia. Residents at the home all have single bedrooms with en-suite facilities. The home provides a variety of communal lounges and dining facilities. There is also a large garden area at the home for residents. Rydal Road Care Home DS0000000746.V267550.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was carried out over a period of 4 hours on the 9th December 2005. The home did not know the inspection was going to take place. The plan for the inspection was to check whether the home had implemented the recommendations made at the previous inspection; to talk with the residents about living in the home; to meet with care staff and the home’s management team; and to look at records. What the service does well: What has improved since the last inspection?
Some areas of the home have been redecorated and some furniture has been replaced. All service users bedroom doors have been fitted with suitable locks. New moving and handling equipment such as hoists and stand aids have been bought so staff can transfer residents safely and comfortably. All trained nurses at the home have had additional training in record keeping and accountability, and all staff during supervision sessions with the manager have looked at induction records to make sure that they are fully aware of the policies and procedures associated with there roles. Rydal Road Care Home DS0000000746.V267550.R01.S.doc Version 5.0 Page 6 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. Rydal Road Care Home DS0000000746.V267550.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 Road Care Home DS0000000746.V267550.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): 3 Assessments of new residents takes place prior to them living at Rydal Care Home. This is to ensure that individual care needs can be met within the service. EVIDENCE: The assessment documentation and recording of a new resident was good and in sufficient detail so as to make it possible for the care needs to be identified and from which a care plan has been developed. The manager confirmed that she visits new residents prior to admission, and takes into consideration the equipment they require and the dependency of the other residents living at the home. Documentation such as care manager assessments were also available for the homes staff to refer to.
Rydal Road Care Home DS0000000746.V267550.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): 7,8, &10 Care plans do not provide staff with enough detail for them to meet all the service users identified needs. Some service users cannot be guaranteed that there dignity and privacy is maintained at all times. EVIDENCE: The recording of how people are cared for has improved since the last inspection however further development of the care plans is needed. Although all service users had a care plan, they were not written in enough detail to ensure that staff could fully understand service users’ needs. It was sometimes difficult to decipher why service users were receiving care, and what care services they were actually receiving. There was no reference in any of the files about the social and psychological needs of people. This was of particular concern where service users suffer from dementia. The care plans in place, which gave details about pressure sore treatment and intervention, were lacking in information. Upon reading the plans it was
Rydal Road Care Home DS0000000746.V267550.R01.S.doc Version 5.0 Page 10 unclear as to what type of dressings were currently being used and how frequently the dressings were being renewed. Some care plans contained pictures of pressure sores to detail improvement, it was unclear as to the size of the sores or if any improvements had been made. This was because measurements had not been recorded at the time of the photograph. In addition there was no evidence to suggest that consent had been gained for these pictures to be taken. The manager confirmed that service users at the home are referred to the tissue viability nurse for advice on treatment on pressure sores and wounds. However there was nothing in the care plans to confirm this had been done. All service users who required specialist pressure relieving air mattresses and air cushions had one. Several new hoists/standaids have recently been purchased. Some of the care plans did contain risks assessments, but these need further work. During the inspection it was observed that a service user was using a wheelchair without any foot rests fitted to it. The nurse that was pushing the chair said that the service user had difficulty keeping there feet on the foot rests, and that was why they had been removed. Upon checking the care plan this was not documented. On a more positive note there was some evidence of thoughtful and creative strategies that had been recorded to ensure residents needs could be met. During the inspection several doctors visited the home, and care plans indicated that residents had access to other health care professionals such as district nurses, opticians and chiropodists. Several residents spoken to said that their privacy and dignity was maintained by staff and that all care was provided discreetly. Rydal Road Care Home DS0000000746.V267550.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): 14 &15 Residents living at the home are supported to have choice and control over how they choose to live. EVIDENCE: Residents confirmed that they could have as many visitors as they like and at any time they chose. The visitors are made to feel welcome during their visits and there were several visitors coming and going during the inspection. One resident was just finishing a late breakfast she said she had just got up after having ‘a sleep in’. Another resident said that she could get up and go to bed whenever she chose and staff were ‘always willing to help make things better and easier for her’ The lunchtime meal was being served during the inspection. It looked nice and service users said they enjoyed it. Staff were able to assist service users who needed help. One service user said that over the past few months the food had improved. They said sometimes it was a ‘bit bland’ but most of the time it was nice. Rydal Road Care Home DS0000000746.V267550.R01.S.doc Version 5.0 Page 12 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): 16 &18 Service users can be confidant that their concerns and complaints are dealt with appropriately and that safeguards are in place to protect them from abuse. EVIDENCE: There has been no complaints at the home since September 2005. During the inspection one service user who had recently been admitted to the home raised some areas of concern with the manager. In particular the lack of staff on duty during the evening and nighttime resulting in some of the residents needs not being met. The manager, resolved straight away the immediate issues, deployed care staff to assist this service user, and then said that she would return later to chat to the service user to make sure that everything that had been done was to the service users satisfaction. The service user was pleased with this outcome. The manager confirmed that all complaints are taken very seriously and that the company has a robust policy and procedure for dealing with complaints about the service. All complaints investigated by the home are documented with the outcome and actions taken recorded. Rydal Road Care Home DS0000000746.V267550.R01.S.doc Version 5.0 Page 13 Staff training has taken place in the protection of vulnerable adults in abuse. Staff recruitment procedures were adequate and staff were employed and deployed following appropriate CRB and POVA checks. The manager and staff team were clear and confident in the protection of vulnerable adult procedures. Rydal Road Care Home DS0000000746.V267550.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): 19&26 People can be assured they live in a safe clean and comfortable environment. EVIDENCE: Suitable door lock have been fitted to all residents bedrooms. There is a redecoration program on going in the home with communal areas and bedrooms being redecorated and refurbished. One service users said that they really liked the newly decorated lounge and the recently repainted corridors were also “looking nice” Some furniture and soft furnishings have also been renewed. All areas of the home inspected were clean and fresh. Rydal Road Care Home DS0000000746.V267550.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): 27,28, & 29 Service users cannot be assured that their needs can be met due to the unsatisfactory staffing levels at the home. EVIDENCE: Three service users spoken to during the inspection said that there was never enough staff on duty. One resident said that staff are always busy, and when you did get change to ask for something to be done it was always done in a hurry. One resident said that staff were nice but she did not like to bother them or be a “nuisance” because they were always “rushed off their feet “ The duty rota was examined. At the time of the inspection the staffing levels during the day time seemed reasonable and the manager said that she was normally around to help if staff were busy. Staff are deployed within the two units of the home. Both units are set over two floors. The dementia unit currently had 30 service users and the general nursing unit had 19 service users. In the general unit the majority of the service users were frail, several of them were nursed in bed continually.5 service users on this unit are suffering from pressure sores. It was of concern that from 20.00hrs until 08.00hrs there were only 2 members of staff deployed in the unit. Given the dependency of service users and the layout of the building it is the inspectors view that there was not enough staff on duty during this time to ensure that service users needs could be met. Rydal Road Care Home DS0000000746.V267550.R01.S.doc Version 5.0 Page 16 The home had staff files in place which provided evidence that the appointment of a new staff member is made through proper recruitment processes. This includes the vetting of staff through the use of references, POVA first checks and Criminal Record Bureau (CRB) checks. Staff training is on going and staff have been supervised. During supervision sessions the new manager of the home has revisited the induction paper work with staff and a ‘refresher’ of roles and responsibilities and company expectations. Rydal Road Care Home DS0000000746.V267550.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): None of these standards were inspected on this occasion EVIDENCE: Rydal Road Care Home DS0000000746.V267550.R01.S.doc Version 5.0 Page 18 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 X 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 1 28 3 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X X X X Rydal Road Care Home DS0000000746.V267550.R01.S.doc Version 5.0 Page 19 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 OP7 Regulation 14 &15 Requirement Timescale for action 28/02/06 2 OP8 15 3 OP27 18 4 OP10 12 The manager must review all care plans to ensure that the plan is up to date with the care that service users are receiving. In addition risk assessments and strategies need to be documented clearly when an area of risk has been identified that may effect the safety and well being of a service user. The manager must ensure that a 28/02/06 Care plans contain more in depth information with regard to pressure sore assessment and treatment. Staff must be employed and 28/02/06 deployed in sufficient numbers to ensure that service users needs can be met at all times In order to promote privacy and 28/02/06 dignity of service users the manager must demonstrate how consent has been obtained to take photographs service users pressure sores. Rydal Road Care Home DS0000000746.V267550.R01.S.doc Version 5.0 Page 20 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 Refer to Standard OP31 Good Practice Recommendations It is recommended that the acting manger submits an application to the commission for social care and inspection to become the registered manager. Rydal Road Care Home DS0000000746.V267550.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Darlington Area Office No. 1 Hopetown Studios Brinkburn Road Darlington DL3 6DS National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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