Inspection on 28/08/07 for Ryedale Court Nursing Home

This inspection was carried out on 28th August 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.

Other inspections for this house

Ryedale Court Nursing Home 02/08/06

Ryedale Court Nursing Home 20/01/06

Ryedale Court Nursing Home 16/06/05

Ryedale Court Nursing Home 09/12/04

Ryedale Court Nursing Home 07/06/04

Ryedale Court Nursing Home 18/09/03

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Ryedale Court Nursing Home Victoria Road Barking Essex IG11 8PE Lead Inspector Ms Gwen Lording Key Unannounced Inspection 10:00 28th August 2007 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 Ryedale Court Nursing Home DS0000015602.V339245.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. Ryedale Court Nursing Home DS0000015602.V339245.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ryedale Court Nursing Home Address Victoria Road Barking Essex IG11 8PE 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) 020 8514 2525 020 8514 2727 Avonpark Care Centre Limited Manager in post but not currently registered with the Commission Care Home 70 Category(ies) of Dementia (70), Dementia - over 65 years of age registration, with number (70), Old age, not falling within any other of places category (70) Ryedale Court Nursing Home DS0000015602.V339245.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. MINIMUM STAFFING NOTICE To include service users in the category Dementia (DE) aged 55 years and over. 29th December 2006 Date of last inspection Brief Description of the Service: Ryedale Court Nursing Home provides nursing care and accommodation for older people who have dementia or physical frailty due to the ageing process. The home is registered to accommodate seventy service users. The registered providers are Avonpark Care Centre Limited. The home has three separate units and the majority of the rooms are single and en suite. There is a passenger lift. The home employs an activities co-ordinator, catering, laundry, housekeeping, administrative and maintenance staff. The home is situated in a residential area of Redbridge on the borders of Barking and is well served by public transport. On the day of the inspection the fees for the home were £569.00 per week. A copy of the Statement of Purpose and Service User Guide is made available to both the resident and the family. This information is also held at the main reception and on all three units. A copy of the most recent inspection report is available on request. Ryedale Court Nursing Home DS0000015602.V339245.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection, which started at 10am and took place over six hours. The inspection was undertaken by two inspectors, namely the lead inspector Gwen Lording and Sandra Parnell-Hopkinson. The manager was available throughout the visit to aid the inspection process. This was a key inspection in the inspection programme for 2007/2008. Discussion took place with the manager; several members of nursing and care staff; kitchen and administrative staff. The inspectors spoke to residents where possible; however due to their care needs it was not possible to fully obtain their views. Visiting relatives and friends were spoken to and asked to give their views on the service and the standards of care in the home. Nursing and care staff were asked about the care that residents receive, and were also observed carrying out their duties. A tour of the premises, including the laundry and main kitchen was undertaken. The files of several residents on each unit were case tracked together with the examination of other staff and home records. This included medication administration; activity programmes; training records; maintenance records; complaints and staff recruitment procedures and files. Information was also taken from a Pre-Inspection Questionnaire, which was completed by the previous manager. Additional information relevant to this inspection was also obtained from monthly Regulation 26 monitoring reports and Regulation 37, notification of events. As part of the inspection process the views of several health care professionals who provide a service to the home were sought and are commented on in this report. Relatives, staff and residents where possible, were asked how people living in the home wished to be referred to. The majority expressed a wish for the term ‘resident’ to be used, as it is their home. This is reflected accordingly in the report. The inspector would like to thank the residents, staff and visitors for their input and assistance during the inspection. Ryedale Court Nursing Home DS0000015602.V339245.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Consideration must be given to the environment to best utilise the layout and design to meet the specialist needs of people living with dementia. For example, through the use of décor, visual cues such as colour, signage and the use of familiar things from a person’s previous setting, such as photographs. More development is needed around identifying and reflecting individuals cultural, religious and social care needs. The care plan should aim to enable the resident to be able to take as full as part as possible in their daily living routines and so allow them as much independence as is possible. All staff working in the home must undertake comprehensive training in caring for people living with dementia, so as to equip them with the relevant skills and knowledge. More work needs to be done by the registered organisation to demonstrate that there will be progress and sustained improvements with regard to the Ryedale Court Nursing Home DS0000015602.V339245.R01.S.doc Version 5.2 Page 7 environment. Major investment is required by the organisation in order to refurbish the home to an improved standard, which will be to the benefit of all current residents and any prospective residents. 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. Ryedale Court Nursing Home DS0000015602.V339245.R01.S.doc Version 5.2 Page 8 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 Ryedale Court Nursing Home DS0000015602.V339245.R01.S.doc Version 5.2 Page 9 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): Standards 3, 4 & 5 People using the service experience adequate quality outcomes in this area. We have made this judgement using all available evidence including a visit to this service. A pre-admission assessment is undertaken for all prospective residents and care plans are drawn up from the information in this assessment. However, not all staff have the necessary specialist skills and ability to meet the needs of people living with dementia. The religion, ethnicity and social/ cultural needs of individual residents must also be identified so that staff understand and are able to meet such needs. The home does not offer intermediate care. EVIDENCE: Individual records are kept for each resident and a number of files were examined on each unit. It was evident from viewing files, including the file of a newly admitted resident that a full assessment of needs is being undertaken by people trained to do so with the involvement of the resident’s family and relevant professionals. Prospective residents are able to visit the home prior to Ryedale Court Nursing Home DS0000015602.V339245.R01.S.doc Version 5.2 Page 10 making a decision regarding moving in, and are able to move in on a trial basis. All records examined had full assessment information recorded around the physical nursing care needs of the residents. However, at the initial preadmission assessment the religion, ethnicity and social/ cultural needs are identified to a limited degree, and this area does need expanding so that staff understand and are able to meet such individual needs. From case tracking and talking to some staff it was evident that the needs and preferences of residents from minority ethnic communities are not always being met, and neither are they understood by some staff. The inspector was satisfied that the physical nursing care needs of residents were being adequately met and understood but very little information was recorded as to the specialist care needs of those residents with dementia. Nursing and care staff have not received adequate and appropriate training to meet and understand the needs of people living with dementia. Such training would equip staff with the relevant skills and knowledge required to ensure good quality care provision for people admitted to the home, and ensure that their specialist needs will be met. The manager advised that further training in dementia care has been identified as a future training need for all staff. The manager was provided with a copy of the Commission’s ‘Policy and Guidance on Provision of Fees Information by Care Homes’. This sets out what information care home providers need to include in the Service User Guide regarding fees and terms and conditions, and is in a format that is easy to understand. Ryedale Court Nursing Home DS0000015602.V339245.R01.S.doc Version 5.2 Page 11 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): Standards 7, 8, 9, 10 & 11 People using the service experience adequate quality outcomes in this area. We have made this judgement using all available evidence including a visit to this service. Residents’ health and personal care needs are set out in individual care plans. The care plans are generally detailed but need to be more specific with regards to the recording of outcomes for residents around the cultural, religious and social care needs of the individual; and the specialist needs of those people living with dementia. There are clear medication policies and procedures for staff to follow, so as to ensure that residents are safeguarded with regard to their medication. EVIDENCE: A total of thirteen residents were case tracked across the three units, and their care plans and related documentation inspected. All had an individual care plan, and there was evidence that care plans were being reviewed on a monthly basis. However, the care plans were very much health related and there was little evidence of the social care needs. With the introduction of the Ryedale Court Nursing Home DS0000015602.V339245.R01.S.doc Version 5.2 Page 12 Mental Capacity Act 2005 it is essential that care and care plans are reflective of ‘informed choice’ by residents, and staff must be aware of the implications of this new legislation in the delivery of care. Generally residents’ health and personal care needs are set out in individual plans but not all of the care plans accurately reflect their current needs. There was limited information on meeting the dementia care needs of residents and in some instances the care plans did not include end of life matters. There were care plans around ‘sleeping patterns’ but these need to be more detailed to include needs such as having the window open/closed, light on/dim/off, and if awake during the night what action to take. Although there was a lack of detailed information in the care plans, in discussions with staff they were able to give good verbal accounts and were generally able to demonstrate a knowledge of the individual health needs of residents. The care plans demonstrated little sense of the person, and therefore, they need to be more person-centred and include strategies/intervention techniques for dealing with the effects of dementia on the individual. For example, there are residents who frequently wander up and down the corridors but the care plans did not evidence any intervention techniques, such as taking the resident out for a walk or endeavouring to engage in distracting activities. Very few care plans evidenced information on the life history of the resident. The gathering of this information for all residents is essential to the delivery of quality care. It could then be used in a more meaningful way in planning individual social activities, and as a basis for staff to gain more insight and knowledge of the resident. As part of case tracking the documentation/health records relating to wound management; the management of diabetes; and a recently admitted resident were examined. The records for these residents were found to be in good order. Documentation around the treatment of pressure sores was detailed and it was evident that the tissue viability nurse had been involved. One resident who had been discharged from a local hospital with 13 pressure sores, now had only 2 as the others had healed. Many of the residents have problems around continence, but there was little evidence of continence care programmes being in place. Very few care plans identified the need for detailed oral health care or for skin care. With all residents there is a need to ensure good skin care, but this is certainly true for some residents from ethnic minorities, and again there was little evidence of care plans around skin care. All residents are weighed on admission and thereafter monthly, and increases/decreases in weight are monitored. However, staff must be more vigilant around the monitoring of weight increases/decreases as one record showed that a resident had gained 3Kgs. one month but had lost 3Kgs. the next month. There was no note as to the fact that the resident may have been Ryedale Court Nursing Home DS0000015602.V339245.R01.S.doc Version 5.2 Page 13 ill during the month, or not been eating or that the scales may have been wrong. Where necessary a referral is made to the GP if the services of a dietician/nutritionist are required, and there was evidence on several files that these services had been requested. Some of the files had written evidence that there is involvement from other health professionals including dentist, optician and chiropodist, as well as GP and hospital outpatient appointments. However, the file of a resident who is bed bound did not show evidence of the involvement of either a dentist or a chiropodist for more than a year. It is essential that all residents have access to these necessary services. Risk assessments are routinely undertaken on admission for all residents around nutrition, moving and handling, falls and pressure sore prevention. The inspectors’ observed the use of lap restraints, for two residents’ who were seated in wheelchair’s. Staff told the inspectors that both these residents’ “could not sit in an armchair as they kept falling”. This was discussed with the manager who will be making a referral to an occupational therapist so that a reassessment of both residents can be undertaken in an endeavour to acquire a more suitable chair. This will hopefully obviate the need for the use of a lap restraint. A number of monitoring charts were examined including blood sugar monitoring, turning charts and food/ fluid intake. These were found to be in good order. Most of the staff talked about residents, and were observed to treat residents, in a respectful and sensitive manner. They understood the need to promote dignity through practices such as in the way they addressed residents and when entering bedrooms, bathrooms and toilets. Staff were observed to be gentle when undertaking moving and handling tasks, but not all staff offered explanation and reassurance throughout the activity. Some members of staff were observed to be ‘leading’ residents by the hand without any interaction at all. It is essential that staff pay more attention to the appearance of residents. For example one gentleman was observed to be wearing a pair of trousers, which should have been full length but only came to his mid calf, and other residents were observed to have buttons missing from some of their clothes. Many of the residents have high dependency needs in relation to their dementia and it was not possible to fully obtain the views of residents spoken to during the inspection. The inspectors’ were able to speak with a number of visiting relatives. Comments from relatives included: “The standard of care varies dramatically, depending on who is on duty”. Other relatives were complimentary:“I am really happy with the care my mum receives, the staff look after her very well”. “My wife is well cared for and there has been a marked improvement in her health”. Ryedale Court Nursing Home DS0000015602.V339245.R01.S.doc Version 5.2 Page 14 “Staff always keep me informed of any changes in my mother’s health”. An audit was undertaken for the handling and recording of medicines within the home and a sample of Medication Administration Record (MAR) charts were examined. These were found to be in good order. Insulin was being stored appropriately in accordance with the instructions for this medication. There was little evidence of meaningful end of life care plans in place, and some just stated ‘burial or cremation’. However, from talking to staff it was evident that residents would be treated with care, sensitivity and respect at the time of death, and that this would also be extended to family and friends. In discussions with the manager it was evident that she is now actively engaged in promoting comprehensive end of life care, and is looking at introducing the Gold Standard Framework. Ryedale Court Nursing Home DS0000015602.V339245.R01.S.doc Version 5.2 Page 15 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): Standards 12, 13, 14 & 15 People using the service experience adequate quality outcomes in this area. We have made this judgement using all available evidence including a visit to this service. Whilst there is a general programme of activities available, consideration needs to be given to planning a more varied and stimulating choice of activities, which are suitable for all residents. The activity programme is currently being reviewed. This will hopefully be reflected in the provision of an imaginative and varied programme, which is in accordance with individual’s capabilities and their changing needs. Residents may benefit from the use of, for example picture menus, finger foods, small nutritious snacks and more flexible eating times to maintain independence, exercise choice around food and eating and still provide a healthy balanced diet. Visiting times are flexible and people are made to feel welcome in the home so that residents are able to maintain contact with their family and friends as they wish. Ryedale Court Nursing Home DS0000015602.V339245.R01.S.doc Version 5.2 Page 16 EVIDENCE: It was apparent that the routines of daily living and activities could be more flexible. Generally residents are got up in the morning for breakfast, with the exception of those residents who are ‘bed-bound’. This was discussed with the new manager during the inspection and she has plans to ensure that routines are more flexible to meet the needs of the residents. For instance, she will be introducing a ‘tray service’ for those residents who prefer to lie in and take breakfast in their bedroom. There is one activities co-ordinator and on the day of the inspection she was undertaking handcare with some of the residents on Oakland. Apart from this there was little evidence of any other meaningful activities being undertaken with residents. The development of life histories for those residents living with dementia would greatly assist in the provision of appropriate activities to these residents. Staff must be aware that such residents have a very short concentration span and therefore the activities need to be more individual or small group focused. It would be beneficial if some resources were left in the lounges so that residents are able to “dip in and dip out” as necessary. The activity programme is currently being reviewed by the new manager and the activity co-ordinator. This will hopefully be reflected in the provision of an imaginative and varied programme, which is in accordance with individual’s capabilities and their changing needs. It is also essential that care staff recognise that activities within a care home are not solely the responsibility of the activities co-ordinator. It is important that care staff are also engaged in enabling residents living with dementia to retain daily living skills such as washing, dressing and choosing clothes. Also to support residents to be involved in activities that focus on the individual’s needs, level of functioning and have some relevance to the individual’s likes, preferences and interests, past and present. This may be time consuming for staff but it is an important element in the care of residents. On the day of the inspection the majority of residents were sat in the lounges with the television on. It was apparent from observation that the majority of the residents were not watching the television but care workers were totally oblivious to this fact. It appeared that some staff felt that if the television was on residents were being entertained. It would have been more beneficial for residents for the television to be turned off, and for appropriate music to be played, or for staff to be interacting with them. Although there is a church service in the home on a monthly basis, the spiritual needs of many of the residents are not being met. This has been discussed with the manager who must take steps to address this important Ryedale Court Nursing Home DS0000015602.V339245.R01.S.doc Version 5.2 Page 17 aspect of the lives of some of the residents. Some of the care plans viewed did not indicate the ethnicity of a resident and some did not indicate the religion or other belief value. In discussions with a member of staff it was evident that she had no real knowledge of the religious or dietary needs of a resident who was a Hindu. Meals are generally served in the dining room and the lounge/dining room on Oakland and in the main dining room on Park. On Park the tables were routinely laid with clothes, napkins and cutlery prior to residents sitting down. However, in the main dining room on Oakland the tables were not appropriately laid and staff were doing this while the residents were sat at the tables waiting for their lunch to be served. The taking of any meal should always be a pleasant experience and tables should always be laid accordingly. It is acknowledged that once tables have been laid there may be some residents, who then proceed to move things, which makes extra work for staff in re-laying the tables. Staff should discuss this and agree on strategies to distract residents rather than act negatively by not routinely laying tables. Any engagement for a resident living with dementia can be a positive experience, and this may also be in picking up cutlery from the dining table as it helps to maintain their engagement with the world around them. Staffing levels must be reflective of the needs of residents. The Inspectors’ were able to observe lunch being served on both Oakland and Park. Whilst menus were varied and balanced they were not reflective of the needs of residents of all residents. Although there were several residents who are from an ethnic minority, they were not always offered meals appropriate to their cultural needs. Kitchen staff were aware of one resident who required a Halal diet and this was being provided. However, in discussions with a member of nursing staff regarding the needs of a resident who was a Hindu, it was apparent that she was not aware of the cultural dietary needs of this individual. This is unacceptable and the manager must ensure that action is taken to address this matter. It is essential that all staff are aware of the type of diet required by a resident and also of any religious implications. Some of the residents needed either supervision by staff or assistance with eating and many of the residents were given a pureed diet although care plans did not reflect the reason why this was necessary. The meals were generally well presented but it appeared that it was the staff that decided what somebody would eat. Service users living with dementia may benefit from the use of, for example pictorial menus, finger foods, small nutritious snacks, smaller portions and more flexible eating times to maintain independence and exercise choice around food and eating. This area does need to be developed through the provision of pictorial menus or other methods such as making available to residents before the actual mealtime, small portions of the meals so that they can see, smell or touch the food and thereby make a more informed choice. Ryedale Court Nursing Home DS0000015602.V339245.R01.S.doc Version 5.2 Page 18 Residents who take their meals in the lounge/dining room of Oakland Unit do have to wait some time before their meals are collected from the main dining room on this unit. Residents were sat at the dining tables for a long time before their meals were served. This is not acceptable as residents get distressed at having to wait, and again the manager must review this aspect of the service. From viewing food and fluid monitoring charts it would seem that many of the residents are given porridge or cereal for breakfast, although the inspectors were told that a cooked breakfast was available each day. The taking of meals should be an enjoyable experience for all residents, and the manager’s attention is drawn to the Commission’s report Highlight of the day that is about food and nutrition within care homes. A visit was made to the kitchen and the Inspector was able to discuss the storage and preparation of food with one of the kitchen assistants. The food is provided by an external catering company and is delivered to the home under cook/chill. This has been in place for approximately three months and the organisation is continually reviewing/ amending the menus and quality of meals. The kitchen assistant was aware of those residents requiring special therapeutic diets, for example diabetic diet, a resident who required a Halal meal and a resident who required a vegetarian meal. However, as previously stated in this report, nursing and care staff were not always so aware of individual’s dietary needs. A fresh green salad and prepared fresh fruits are available at each meal. The use of full cream milk, butter and cream is used wherever possible to supplement the diets of those residents with reduced food intake/ diminished appetite. Comments from visiting relatives on the quality of food was very variable: “ I have tasted some of the food myself and it’s very good” “Looks appetising and my wife seems to enjoy it”. “Poorly presented and unappetising” “The food is not as nice since the changeover” However, on the day of the visit the food was generally well presented, smelled appetising and residents appeared to be enjoying their meals. Visiting times are flexible and relatives/ friends are encouraged to visit. Relatives spoken to commented that they felt very welcomed by staff and were encouraged to visit at any time. Several spouses of residents visit every day and spend a good part of the day with them in the home. Ryedale Court Nursing Home DS0000015602.V339245.R01.S.doc Version 5.2 Page 19 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): Standards 16 & 18 People using the service experience good quality outcomes in this area. We have made this judgement using all available evidence including a visit to this service. The home welcomes complaints, concerns and suggestions about all aspects of the service and uses these postively to help improve service provision. Staff working in the home have received training in safeguarding adults to ensure that there is a proper response to any suspicion or allegation of abuse. EVIDENCE: There is a written complaints policy and procedure for dealing with complaints and this is clearly displayed in the home. The complaints log was inspected and indicated complaints received, details of investigation, action taken to resolve and the outcome for the complainant. The most recent complaint recorded was around the quality of food and this is being actively addressed by the manager. The manager was clear that any complaints received by the home would be responded to in writing and in accordance with the home’s complaint procedure and stated timescales. All staff working in the home receive training in safeguarding adults and this is included in induction training for all new staff. Those staff spoken to were conversant with the action to be taken if they had any concerns about the safety and welfare of residents or if they witnessed any suspected abuse. Ryedale Court Nursing Home DS0000015602.V339245.R01.S.doc Version 5.2 Page 20 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): Standards 19, 20, 24 & 26 People using the service experience poor quality outcomes in this area. We have made this judgement using all available evidence including a visit to this service. Generally the environment within the home was not of a good standard. The physical environment must be improved as it currently does not meet the needs of people who use the service, including the specialist needs of people living with dementia. EVIDENCE: A tour of the whole home was undertaken at the start of the inspection, accompanied by the manager, and all areas were visited again later during the day. Some bedrooms were seen either by invitation of the resident, or with permission, whilst others were seen because the doors were open or being cleaned. Ryedale Court Nursing Home DS0000015602.V339245.R01.S.doc Version 5.2 Page 21 Isolated areas of the home, especially on the ground floor between Park and Garden had a very offensive smell on the day, and many areas of the premises showed signs of a build up of dirt. There is now a new housekeeping regime and major efforts are being made by the domestic staff to thoroughly clean all parts of the building. However, it was apparent that the carpets in the communal corridors and possibly some other areas need replacing as, in spite of a deep clean, they remain stained and have an offensive odour. With the exception of a lounge, dining room and corridor on Oaklands, the lounge on Garden and several of the bedrooms, which have recently been refurbished/ redecorated, the home is in urgent need of a complete redecoration. This is was a requirement made at the last key inspection. In discussions with one relative the inspector was told “The cleanliness in the home has recently improved but still had a long way to go.” Those bedrooms that have been re decorated are much improved with new bedroom furniture, curtains and bed linen. Residents living in the home and their relatives should be assured that the home will be decorated and cleaned to a good standard, and maintained to that standard at all times. Any new resident moving into the home should not be expected to move into a room that has not been redecorated to a good standard. Some bedrooms were seen to be very personalised but this was in stark contrast to other bedrooms visited, which gave no indication of being personalised, nor were they representative of the occupant’s culture, religious or personal interests. Relatives should be encouraged to bring in items that are familiar to the person living with dementia, as this will make their environment more personal and meaningful. Generally the home was devoid of appropriate signage and décor suited to the needs of a home registered to care for people living with dementia. It is essential that appropriate signage is used throughout the home, as the ability of people living with dementia to communicate with words decreases, the use of non-verbal cues and the environment are important in enabling them to cope better with daily life and aids to orientation. The general environment on the units must reflect good practice guidance on dementia care within care homes. Consideration must be given to utilising the existing design and layout of the units to meet the specialist needs of people living with dementia. For example, through the use of visual cues such as colour and signage. Containers with suitable materials could be located around the units so that those residents who can walk can touch and feel things. There were few appropriate pictures in the corridors, lounges or dining rooms. The manager must give consideration to ensuring that there are items of Ryedale Court Nursing Home DS0000015602.V339245.R01.S.doc Version 5.2 Page 22 interest for residents throughout the home. Pictures of local areas of London can be obtained from the local library and these can also be used as points of discussion with residents living with dementia. Boards with different materials stuck to them can be displayed on the walls, and this will aid to the enjoyment of residents who are walking along the corridors as they can touch different types of material. The placing of magazines and ornaments at a level that can be reached by residents will also aid in activities for residents. The physical environment has an enormous impact on how the strengths and skills of people living with dementia are supported or not. Changes mentioned above if implemented can help to support people living with dementia, and help to maximise independence and minimise confusion. Therefore, since the service is registered for the provision of care to people living with dementia, and this is viewed as a specialist service the organisation must consider improvements to the environment as follows: Using changes in colour in different areas to help with orientation Having toilet seats that are a different colour to the rest of the room to help with identification, and this includes the en suites. Using pictorial signs as well as written signs and ensuring these are at the right height to help with identifying different rooms and areas Providing freedom to walk about in areas that are interesting and that have pictures and sitting areas. There is a small rear garden was well maintained and there were seating areas for residents. On the day of the inspection it was not evident that the garden was being used by any of the residents. It is essential that all residents are given the opportunity to enjoy the garden on a pleasant day, but again this will have implications for staffing levels. The manager has received information and is fully aware of the recent legislation regarding smoking in care homes, which came into effect on the 1st July 2007. There are currently some residents living at Ryedale Court who smoke, and the organisation must make suitable arrangements for these people. There is a full time maintenance person who has recently commenced in post. The manager must ensure that there is an effective system in place for staff to report items requiring minor repair or attention. The following was noted during the inspection: • Bathroom (Garden) – light over mirror and soap dispenser both broken. • Room 25 (Garden) - torn fabric on armchair • Bathroom (Park) - where paper towel and soap dispenser had been re-sited the walls had not been made good. Ryedale Court Nursing Home DS0000015602.V339245.R01.S.doc Version 5.2 Page 23 The laundry area was visited and there were a large number of black bags containing rubbish being stored in this area. During this visit it was not possible to speak to a member of the laundry staff but this was discussed with the manager who will be making arrangements for these to be removed. Ryedale Court Nursing Home DS0000015602.V339245.R01.S.doc Version 5.2 Page 24 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): Standards 27, 28, 29 & 30 People using the service experience adequate quality outcomes in this area. This judgement has been made using all available evidence including a visit to this service. The home employs staff in sufficient numbers to meet primarily the personal and nursing needs of the residents. However, the increased needs of residents with dementia at peak periods, such as mealtimes and social activities, may mean staffing levels being increased at these times. Staff need additional training to more effectively understand and meet the needs of people living with dementia. The procedures for the recruitment of staff are robust and provide safeguards for people living in the home. EVIDENCE: The staffing levels of qualified nurses and care staff were sufficient to meet the nursing and personal care needs of residents. However, staffing levels need to be reviewed especially during meal times and to enable activities to be more reflective of the needs and choices of residents such as enabling more community visits and contacts. At all times there must be enough staff available to meet the needs of people using the service, with more staff being available at peak times of activity. The staffing structure must be based around delivering outcomes for people using the service. Ryedale Court Nursing Home DS0000015602.V339245.R01.S.doc Version 5.2 Page 25 The majority of staff have received one day’s training in Dementia Awareness However, staff must undertake more in depth and comprehensive training in caring for people living with dementia. The registered organisation must consider this to be priority training need for all nursing and care staff, so as to equip them with the relevant skills and knowledge to ensure good quality care provision to residents. A record is maintained of staff training and records showed that staff have undertaken training in essential areas such as fire training, manual handling, food & hygiene and safeguarding adults. Future planned training includes a four day training course in ‘End of Life Care and Bereavement’; and management of diabetes. The pre-inspection completed by the previous manager stated that 68 of care staff are qualified to National Vocational Qualification (NVQ) level 2 or above. Avonpark Care Centre Limited; as an organisation, employs a workforce from diverse cultures and backgrounds. It was apparent that the ethnicity of the majority of the staff team is not generally reflective of that of the resident group. It is important therefore that the registered persons ensure that staff working in the home receive the necessary training in equality issues and valuing diversity, so that the needs of all residents can be understood and appropriately met, wherever possible. The files of the three most recently employed staff were inspected and these were found to be in good order with necessary references, Criminal Records Bureau (CRB) disclosures and application forms duly completed. Ryedale Court Nursing Home DS0000015602.V339245.R01.S.doc Version 5.2 Page 26 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): Standards 31, 33, 35 & 38 People using the service experience adequate quality outcomes in this area. We have made this judgement using all available evidence including a visit to this service. The manager is a very experienced and well-qualified person. As she has only been in post for six weeks it was not possible to assess these standards fully. However, She has a clear understanding of what improvements are needed and the key areas in which the home needs to further develop. More work needs to be done by the organisation to demonstrate that there will be progress and sustained improvements with regard to the environment, which will be to the benefit of people living in the home. EVIDENCE: The manager has only been in post for six weeks. She is an experienced, wellqualified person, holds a registered nursing qualification, and has previous Ryedale Court Nursing Home DS0000015602.V339245.R01.S.doc Version 5.2 Page 27 experience of working in similar care settings. Since the new manager has been in post she has been holding staff meetings and meeting with relatives in order to introduce herself, set out her vision for the home and answer any queries people may have. Minutes of meetings show that she has an open approach and welcomes comments. She is committed to build a strong staff team and work to improve the service, in partnership with the families of residents and professionals. She has highlighted areas where improvements are needed and is developing an action plan for undertaking this work. This includes improving and developing systems that monitor practice and compliance with the home’s policies and procedures. Support from the parent organisation in progressing such developments and improvements is vital to ensuring an increased quality of life for people living in the home. The manager must submit an application to the Commission to be registered as the manager. The manager stated that the formal supervision of staff has been inconsistent. However, she is planning to reinstate regular supervision, which will include observational and peer supervision. Currently the manager does not act as an appointed agent for any resident. Residents’ financial affairs are managed by their relatives/ representatives. The home has responsibility for the personal allowances of several residents. Through discussion with one of the home’s administrative staff and records inspected, there was evidence to show that residents’ financial interests are safeguarded. Secure facilities are provided for the safekeeping of money and valuables held on behalf of residents’. The responsible individual undertakes Regulation 26 monitoring visits on a monthly basis to report on the quality of the service being provided in the home. The registered providers are responsible for ensuring that there is a robust programme of refurbishment and redecoration of the premises. More work needs to be done by the organisation to demonstrate that there will be progress and sustained improvements with regard to the environment, which will be to the benefit of people living in the home. A wide range of records were looked at including fire safety, water temperature checks, lift service/ maintenance and accident/ incident reports. Fire risk assessments had been undertaken in line with the new fire regulations. Ryedale Court Nursing Home DS0000015602.V339245.R01.S.doc Version 5.2 Page 28 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 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 2 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 1 2 X X X 2 X 2 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 2 X 3 2 X 2 Ryedale Court Nursing Home DS0000015602.V339245.R01.S.doc Version 5.2 Page 29 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 OP13 Regulation 16 Requirement Timescale for action 31/12/07 2. OP19 OP20 OP24 3. OP3 OP4 4. OP4 The home must provide a more varied programme of activities, which are suitable to the needs of individual residents. This will ensure that all residents have a sufficiently stimulating and varied choice of activities. (Timescale of 31/10/06 not met) 23 The refurbishment programme 31/12/07 must be progressed to ensure that all parts of the home are clean and well maintained. This will ensure that the care home is always operated in the best interests of residents’. (Timescale of 30/09/06) 14, 12, 18 The registered providers must 30/11/07 ensure that staff individually and collectively have the required skills, experience and training to deliver the service and care which the home offers to provide. 14 The registered providers must 31/10/07 ensure that during the initial preadmission assessment the religious, social and cultural needs of the residents are clearly DS0000015602.V339245.R01.S.doc Version 5.2 Ryedale Court Nursing Home Page 30 5. OP7 OP8 OP11 12 & 15 6. OP15 OP27 18 7. OP19 OP20 OP24 23 8. OP27 OP30 18 9. OP31 8 10. OP32 OP33 OP36 OP38 9 & 24 identified. The registered providers must ensure that all residents have a care plan, which shows how all their health, personal, and social care needs are to be met. Care plans must be more specific with regard to the recording of religious and cultural needs; the specialist needs of people living with dementia, and include End of Life choices and decisions. The registered providers must undertake a review of staffing levels to ensure that there are sufficient staff at peak times, such as mealtimes and when undertaking social activities. The registered providers ensure that the existing layout and design of the environment reflects good practice guidance on dementia care with care homes, so as to ensure that the specialist needs of people living with dementia are being met. The registered providers must ensure that all staff working in the home receive comprehensive and accredited training in caring for people with dementia. The registered providers must submit an application for the manager to be registered with the Commission. The registered providers must ensure that there are effective and robust systems in place for monitoring practice and compliance with the home’s policies and procedures and in line with the home’s Statement of Purpose. 30/11/07 30/11/07 28/02/08 28/02/08 30/09/07 30/11/07 Ryedale Court Nursing Home DS0000015602.V339245.R01.S.doc Version 5.2 Page 31 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 Ryedale Court Nursing Home DS0000015602.V339245.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford IG1 4PU 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. Extracts may not be used or reproduced without the express permission of CSCI Ryedale Court Nursing Home DS0000015602.V339245.R01.S.doc Version 5.2 Page 33 - 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. 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