CARE HOMES FOR OLDER PEOPLE
Ryland View Arnhem Way Great Bridge West Midlands DY4 7HR Lead Inspector
Mrs Amanda Hennessy Unannounced Inspection 10th January 2006 11:00 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 Ryland View DS0000004818.V278035.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Ryland View DS0000004818.V278035.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Ryland View Address Arnhem Way Great Bridge West Midlands DY4 7HR 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) 0121 520 1577 0121 557 0859 www.bupa.com BUPA Care Homes (CFHCare) Limited Laura Williams Care Home 140 Category(ies) of Dementia - over 65 years of age (60), Old age, registration, with number not falling within any other category (44), of places Physical disability (26), Terminally ill (10) Ryland View DS0000004818.V278035.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. 5. 6. That 14 elderly (OP) service users and 10 service users with a terminal illness (TI) be accommodated on Bloomfield Unit. There will be two registered nurses on duty at all times between 09.00 to 21.00 hours on Bloomfield Unit That 30 service users with dementia (DE)(E) 58 years and over will be accommodated on Heronville Unit That 26 physically disabled (PD) service users 18 years and over will be accommodated on Palethorpe Unit That 30 service users with demetia (DE)(E) who are 58 years and over will be accommodated on Manby Unit. One service user identified in the variation application of 29.11.04 may be accommodated on Manby Unit who is 56 years and over. This will remain until such time that the identified service users placement is terminated and whilst the home is able to meet her needs. That 30 service users who are elderly and do not fall within any other category (OP) who are 58 years and over will be accommodated on Haines Unit. That the variation granted on the 5 September 2005 for one male service user with learning disabilities who is over 65 years and will be accommodated on Palethorpe House, will only be for the lifetime of that identified service user and whilst the home is able to meet his needs. 19 and 20 April 2005 7. 8. Date of last inspection Brief Description of the Service: Ryland View is a large home accommodating up to 140 service users within five separate, purpose built and spacious bungalows. The bungalows have each been named and are called Bloomfield, Haines, Manby, Palethorpe and Heronville. Bloomfield accommodates up to 24 residents who require continuing care, may require palliative care and who are 58 years old and above. Haines accommodates up to 30 elderly frail residents. Manby and Heronville each accommodate up to 30 elderly people who have dementia. Palethorpe accommodates up to 26 physically disabled service users who are 18 years and over. All units can accommodate people with nursing needs. All bedrooms in each bungalow are single occupancy. There are four ensuite bedrooms on Bloomfield the remainder of bedrooms on all units have toilet and bathroom facilities close by. Each unit has a large communal lounge/dining room and small quiet lounge in addition both Bloomfield and Palethorpe have
Ryland View DS0000004818.V278035.R01.S.doc Version 5.1 Page 5 an additional lounge. Bloomfield also has a large meeting room that is frequently used for teaching sessions. There is also a small kitchenette on each unit where drinks and snacks can be prepared. There are a wide range of aids and adaptations such as grab rails, assisted baths, hoists available for people who need are dependent on each unit. A central laundry and kitchen are also situated in this in a separate block with the administration offices. The home is situated off Arnhem Way, Tipton, has ample car parking and is accessible by car and public transport. Ryland View DS0000004818.V278035.R01.S.doc Version 5.1 Page 6 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection undertaken by one Inspector between 11.0 and 18.30 on the 10 January 2006 and 10.30 to 17.00 hrs on the 11 January 2006. The inspection included a review of records, talking to service users, relatives and staff and a review of medication practices. Ryland View is privately owned by BUPA Care Homes (CFH Care) Limited. The home’s manager is Mrs Laura Williams. Twenty-nine of the previous thirty-five requirements were found to have been addressed, four new requirements were made as a result of this inspection. What the service does well: What has improved since the last inspection?
The home has addressed a remarkable twenty-nine standards since the previous inspection. Requirements that have been addressed include: the identification of the refurbishment plan which has addressed some of the outstanding environmental requirements and the continued refurbishment of the home, training to address the specialist needs of service users, measures to minimise the risk of cross infection and more robust recruitment and selection and the continued development of care records.
Ryland View DS0000004818.V278035.R01.S.doc Version 5.1 Page 7 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. Ryland View DS0000004818.V278035.R01.S.doc Version 5.1 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 Ryland View DS0000004818.V278035.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): No standards were assessed in this section. EVIDENCE: Ryland View DS0000004818.V278035.R01.S.doc Version 5.1 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,10 Care plans do not consistently demonstrate the involvement of residents and their representatives. Service users privacy and dignity is generally respected. EVIDENCE: There has been continued progress in residents care plans and care risk assessments. All units evaluate residents care plans at least monthly with four of the five units ensuring that there is a record that this review involves either the resident or their representative. Visitors spoken to on all units said that they felt that they were fully informed of any changes in their relative’s health. There has been improvement in the frequency that residents and particularly new residents are weighed. The frequency that residents are weighed is identified by their nutritional risk assessment which was met in all but one service user whose risk assessment identified that they should be weighed weekly but was being weighed monthly. Care records reviewed during the inspection and records forwarded to the Commission for Social Care Inspection demonstrate that there is good and timely liaison between staff at Ryland View and other health professionals in relation to residents’ health and well being. Staff call service user, by their preferred name and were seen to knock of service users bedroom, toilet and bathroom doors. Staff on Heronville need to
Ryland View DS0000004818.V278035.R01.S.doc Version 5.1 Page 11 ensure that they consistently ensure that their service users privacy and dignity is respected, four service users had been dressed in their nightwear and were sat back in the lounge at 18.15hrs. The first day of the inspection was cold but not all service users were wearing tights or socks yet staff were unable to say that this was their choice. Staff also need to ensure that residents wear tights or socks should this be their choice. Ryland View DS0000004818.V278035.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 The home matches resident’s expectations and preferences and satisfies their social, cultural, religious and recreational needs. Food served is nutritious and well balanced and offers a healthy and varied diet for residents. EVIDENCE: Residents spoken to said that they are able to exercise choice and have autonomy living at Ryland View. Residents specifically stated that they get up and go to bed when they want to, choose where they had their meals and what they had to eat. The home has the advantage of having an Activities Organiser employed for each unit with a planned activities programme. The Activities Organisers spoken identified the importance of both planned activities and one to one sessions spent with residents who have limited comprehensive, and are unable or unwilling to take part in group activities. Residents can choose what activities that they take part withy residents on Palethorpe thoroughly enjoying an impromptu sing and dance. Palethorpe residents also said how much they enjoy the regular cooking sessions. Residents from are able to benefit from the large site and can watch the entertainment being held on other units. It was lovely on the second day of the inspection to see a number of residents from each house coming to see and join in with entertainment being held on Bloomfield. Residents, visitors and staff said that they had really enjoyed Christmas at the home with its many activities which have included: a
Ryland View DS0000004818.V278035.R01.S.doc Version 5.1 Page 13 Christmas quiz night, carol singers followed by sherry and mince pies, pantomime, Tree of Light remembrance, Christmas parties and entertainment for each unit, several visitors also had also been able to have Christmas dinner with their relative which was also appreciated. Visitors to each unit during the inspection confirmed that they are able visit at any time and are always made welcome by the staff. Visitors also said that they are able to visit their relative in either their own room or in one of the lounges. The home has a four weekly menu which offers choice tasty and nutritious food. The main meal of the day is served at 17.00hrs but a cooked option is available at each meal. Breakfast is served from 7.45 until approximately 10.30 Lunch is served around 12.45. Tea is served around 17.00. Staff confirm that snacks and a milky drinks is available in the evening. Residents or their families are asked for their choice of meal for the next day. Residents spoken to also made positive comments about the food and choice of meals that are available. Staff were seen to offer discreet assistance to residents cutting up their food and feeding those residents who are totally dependent. Special cutlery and plate-guards are also used to assist residents to maintain their independence. The Chef is highly motivated and enthusiastic to provide as much pleasure and satisfaction with food and catering facilities that are available at Ryland View. The Chef spoke to each service user or representative before Christmas to identify preferences in alcohol drinks for residents over the Christmas and New Year holiday. The Chef also feels that “ being a resident for a day” has also assisted the catering staff to provide meals in the format and consistently that residents need. Ryland View DS0000004818.V278035.R01.S.doc Version 5.1 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 The home has appropriate policies and procedures to highlight concerns and complaints. EVIDENCE: The home’s complaints procedure meets all requirements of the regulations. A copy of the complaints procedure is displayed in each unit and in the administration centre and is also in the service user guide and statement of purpose. No complaints have been received by the Commission for Social Care and Inspection in the previous twelve months. The log of complaints made directly to the Manager show that all complaints are appropriately responded to within required timescales. Residents and their families spoken to said if they had any concerns they would discuss them with the Home Manager. Ryland View DS0000004818.V278035.R01.S.doc Version 5.1 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 The home is homely, clean and free from offensive odour although some accommodation is basic. EVIDENCE: All units were visited and were found to be clean and free from any offensive odour. The home does now have an identified refurbishment programme with the lounge, corridors and half the bedrooms on Haines House have recently or are about to be refurbished. The décor and furnishing after ten years are showing their age making the accommodation in parts look basic and detracting from the good reputation of quality care that the home provides. The home has appropriate policies and procedures to minimise the risk of cross infection for its residents. Ryland View DS0000004818.V278035.R01.S.doc Version 5.1 Page 16 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): 29 Recruitment and selection procedures are robust and safeguard service users. EVIDENCE: The staff records seen contained all required information and meet the requirements of the regulations. Ryland View DS0000004818.V278035.R01.S.doc Version 5.1 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): 33,35 The home is run in the best interests of service users with their financial interests also safeguarded. EVIDENCE: The home does have a quality plan. The home manager conducts monthly audits of accidents, incidence of pressure sores, complaints with all incident reports also being reviewed by the Operations Manager. A service user survey has been undertaken a summary of the findings need to be undertaken with the results feedback to service users and all interested parties. Staff can be rewarded customer service can be re The home has addressed the majority of outstanding requirements. Secure facilities are available for the safe keeping of service users personal money and valuables. Written records are available for all transactions which detail the reason for the withdrawal and two signatures, receipts are available as proof of purchases. A review of receipts identified that some purchases had
Ryland View DS0000004818.V278035.R01.S.doc Version 5.1 Page 18 attracted “loyalty points” yet it was not evident that these “loyalty” points had benefited the service user. Regular external audits of service users personal money are undertaken. Services users are able to control their own finances if they want to and are able to but the majority of services users have their finances managed by their families or Court of Protection. Ryland View DS0000004818.V278035.R01.S.doc Version 5.1 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 x x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 x 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 x 2 x x x x x x 3 STAFFING Standard No Score 27 x 28 x 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x 2 x 2 x x x Ryland View DS0000004818.V278035.R01.S.doc Version 5.1 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 OP3 Regulation 14(1)(b) (c) Requirement The home must ensure that service users and their representatives are involved in the assessment of the service users needs and this is recorded in that assessment. Staff must ensure that the pre-admission assessment includes all areas identified by the National Minimum Standards for Older People Partially met. All service users have a pre admission assessment. Four of the five units had records of the involvement of the serviice user or their representative. This requirement was made at the inspection undertaken in September 2002 Timescale for action 31/01/06 2 OP7 15 The service user and or their 31/01/06 relative’s representatives are involved with the drawing up of the care plan and sign to confirm this and their agreement with the care plan. The residents social care needs are identified in the care plan. Partially met. Four out of five of
DS0000004818.V278035.R01.S.doc Version 5.1 Page 21 Ryland View the units evidenced this. This requirement was made at the inspection undertaken in September 2002 3 OP8 15 All service users are weighed regularly as identified within their nutritional assessment. This requirement has been ongoing since the inspection undertaken in February 2003 Partially met. Four of the five units met this requirement. The home must ensure that: The amount of medication received into the home is documented as well as the date, and the person receiving the medication must initial this. Partially met. Staff must ensure that residents wear tights or socks should this be their choice. Staff must ensure that residents are only dressed in their night attire and brought into the lounge if this is their choice and this is documented. The home is assessed by a suitably qualified person who has a specialist knowledge of the client groups catered for, and provides evidence that recommended disability equipment has been secured or provided and environmental adaptations have been made to meet the needs of service users. Partially met. Assessments have been undertaken of Heronville, Manby and Bloomfield. This requirement was made at the inspection undertaken in September 2002 Provision of locks on all bedroom doors This was originally required for completion by June 2002
DS0000004818.V278035.R01.S.doc 31/01/06 4 OP9 13(2) 31/01/06 5 6 OP10 OP10 12(2) 12(2) 31/01/06 31/01/06 7 OP22 16,23 31/03/06 8 OP24 16(2) 31/03/06 Ryland View Version 5.1 Page 22 9 OP33 35 10 OP35 13(6) Partially met Locks are are available on the bedroom doors of Manby, Palethorpe and Heronville The findings of the service user survey must be incorporated into a report that is shared with service users and all interested parties. Staff must not benefit from loyalty points awarded as a result of purchases made by or on behalf of service users. 31/03/06 31/01/06 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 Ryland View DS0000004818.V278035.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Halesowen Record Management Unit Mucklow Office Park, West Point, Ground Floor Mucklow Hill Halesowen West Midlands B62 8DA 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 Ryland View DS0000004818.V278035.R01.S.doc Version 5.1 Page 24 - 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!
