Inspection on 11/09/06 for Ryland View

This inspection was carried out on 11th September 2006.

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

Ryland View 27/08/09

Ryland View 28/05/09

Ryland View 25/11/08

Ryland View 25/06/07

Ryland View 10/01/06

Ryland View 20/04/05

Ryland View 18/01/05

Ryland View 18/01/05

Ryland View 18/01/05

Ryland View 18/01/05

Ryland View 12/01/05

Ryland View 21/04/04

Ryland View 21/04/04

Ryland View 20/04/04

Ryland View 20/04/04

Ryland View 19/04/04

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Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Ryland View Arnhem Way Great Bridge West Midlands DY4 7HR Lead Inspector Mrs Amanda Hennessy Key Unannounced Inspection 11th September 2006 09:00a 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.V309876.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. Ryland View DS0000004818.V309876.R01.S.doc Version 5.2 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.V309876.R01.S.doc Version 5.2 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 dementia (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. The variation granted on the 31 May 2006 for one male service user who is 54 years will only be for the lifetime of that identified service user and whilst the home is able to meet his needs. 20th April 2004 7. 8. 9. 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. 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 Ryland View DS0000004818.V309876.R01.S.doc Version 5.2 Page 5 by. Each unit has a large communal lounge/dining room and small quiet lounge in addition both Bloomfield and Palethorpe have 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. Fees vary between £439 and £714 and are dependant on the needs of the service user and the type of room that will be occupied. Items that are not covered by the fee include hairdressing, chiropody and newspapers. Ryland View DS0000004818.V309876.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection undertaken by two Inspectors between 09.00 and 19.30 on the 11 September 2006 and 07.30 to 17.00 hrs on the 12 September 2006. The inspection included a tour of the home, talking to service users and staff, a review of information supplied by the Manager (pre inspection questionnaire) was also undertaken and expanded upon during the visit. Care records were reviewed as part of the “case tracking” of three to four service users on each unit. Six of the previous ten requirements were found to have been addressed, eighteen new requirements were made as a result of this inspection. Seven immediate requirements were made at the time of the inspection. The Inspectors would like to thanks the homes staff and service users for their assistance and hospitality during the inspection. What the service does well: What has improved since the last inspection? What they could do better: The must take steps to provide a more person centred approach to the care of people with dementia in the home, this should include regular training and Ryland View DS0000004818.V309876.R01.S.doc Version 5.2 Page 7 support for all care staff on the dementia care units and a reduction in a task focused approach to care working. There must be systems put into place that address the monitoring of service users nutritional status, the use of bed rails without a full assessment and the provision of pressure relieving equipment throughout the home. Staff training and induction must be improved to ensure that staff have the knowledge and skills to meet the needs of the service users. A review of the number and skill mix of staff is required to ensure that service users needs are consistently met. 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.V309876.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 Ryland View DS0000004818.V309876.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3,4 The outcome indicator for this group of standards was judged to be adequate. Service users have an assessment of their needs but this is not always fully completed on all units which does not give assurance that the home will be able to meet their needs. EVIDENCE: All service users have an assessment of their needs prior to agreement by the home that they will be able to meet their needs. Unfortunately assessments were not always fully completed making it difficult for their care to be planned or reviewed. This means that planning individual care for service users will be difficult, as their needs will not be reflected from a thorough assessment. It was evident that in some cases service users and their families had been involved with the process but the home must take steps to include service users and their representatives at all times. Staff training records were seen on all units, it was disappointing to see that the majority of staff who were working on the dementia care units had not Ryland View DS0000004818.V309876.R01.S.doc Version 5.2 Page 10 received any training in dementia care or “behaviour that challenges”. Care is based on task completion rather than a person centred approach. This means that service users will have their basic needs met but there is little evidence of specialist care that people with dementia require. Staff had however received training on other units in palliative care and other specialist subjects. Ryland View DS0000004818.V309876.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 The outcome indicator for this group of standards is judged to be adequate. Health and personal care is generally good on three of the five units with service users having their needs met, however health and personal care on two of the units is an area of concern and must be addressed to ensure that service users received require care and have their health care needs met. EVIDENCE: All service users have a plan of care. Service user plan set out the tasks care staff need to complete to meet the majority (but not all) of service users needs. Care plans need to be person centred and not task orientated. Care plans are reviewed at least monthly and in some cases it was clear the service users had been involved in the process. There were some shortfalls that the home needs to address to ensure that service users needs are met at all times and that the risk of harm is reduced, for instance, pressure relieving equipment throughout the home was insufficient to meet the assessed needs of the service users. Staff on all units reported problems obtaining pressure relieving mattress and alternating cushions. Nutritional screening is undertaken by staff for all service users but Ryland View DS0000004818.V309876.R01.S.doc Version 5.2 Page 12 of those records seen most of the screening was not a reflection of current service users needs and this places them at increased risk of malnutrition because staff are not highlighting risks, such as weight loss, or drawing up a risk reduction plan to meet their needs. An immediate requirement was made on the home to review all service users nutritional risk assessments on Manby due to concern about the inaccuracy of the nutritional risk assessments seen and the weight loss of some of the service users that were case tracked on this unit. Where service users have been assessed as needing bed rails to keep them safe whilst they are in bed, risk assessments had not been reviewed and in some cases not completed. This means that the need for bed rails is not reviewed regularly as recommended and other means of managing service users safety may not have been explored. Procedures in relation to medicines throughout the home are generally good. There are areas that need to addressed the most concerning aspects being that staff do not consistently sign for the administration of lotions and creams which resulted in gaps in the medication record. An immediate requirement was given to the home requiring that treatment room where medicines are stored is below 25°c. On two of the units service users were observed to be sitting alone unsupervised for up to forty- five minutes whilst care staff completed other tasks. Service users were seen displaying repetitive behaviours such as banging their fists on tables or shouting for help. On one unit some of the service users were seen to be scratching themselves and had rashes, one service user appeared to be in so much discomfort they removed their clothing to enable them to scratch their skin and sat for some time with their breasts exposed until a member of staff noticed and helped them to dress. An immediate requirement was made requesting that the cause of the rash was investigated. Another service user had been incontinent and needed to be changed and made comfortable, staff assisted the service users with the hoist unfortunately when they did this all of the people in the day room were able to see their underwear and continence products. In these situations staff must consider how they will manage service users dignity at all times. Other issues highlighted included one service user being unable to communicate effectively with staff because of a language barrier, it was disappointing to note that despite being in the home for over a year little attempt had been made to improve communication for this service user. Ryland View DS0000004818.V309876.R01.S.doc Version 5.2 Page 13 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 outcome indicator for this group of standards is judged to be adequate. The majority of service users find that the homes generally meets their expectations and preferences and are generally helped to exercise choice and some control over their life. EVIDENCE: Each of the units has an activity therapist who helps provide activity and social stimulation for the majority of service users. Service users were seen playing games and stated that they enjoyed some of the activities on offer. “they do try hard to get us involved but sometimes I just want to sit and be quiet”, “they take them to the other unit to play bingo”, “I take them into town sometimes and we have tea and cakes they seem to really like this”. Further development in activities is also required for those service users with dementia. Visitors are welcome to the home at any reasonable time, visitors who wish to visit either late at night or early in the morning are advised to contact the nurse in charge. Mealtimes were observed and can be chaotic on some units due to the dependency of the service users and requiring staff assistance. On one unit there were fifteen service users who required assistance to eat their meals and Ryland View DS0000004818.V309876.R01.S.doc Version 5.2 Page 14 four care staff to help them do it. As staff began helping some service users to eat their meals, others were left waiting and watching until staff were free to help them. One service user was left in her room to feed herself egg and chips she was shouting for assistance but staff were too busy to help. This lady asked the Inspector to help her but she had no cutlery, the food was cold and unappetising. When this was brought to the Managers attention she agreed that this lady does need assistance to eat and should not have been left alone to feed herself. Meals are generally served from 8:00am until 10:30am for breakfast, 12:30p.m, for lunch and 16:30p.m for tea. Staff stated that many of the service users go to bed early and do not have supper this means that the last meal of their day is tea at 16:30 hrs and they have to wait until breakfast the following morning for food. This is particularly concerning as service users on this unit are losing weight. The home was given an immediate requirement that service users do not have a gap of more than twelve hours between the last meal of the day and breakfast the next day. Breakfast was still being served on three units at 11.20 as service users were got up and brought into the lounge, although by this time there were no hot choice available and lunch is then served at 12.30. In addition service users on Heronville only had one hot drink during the morning which seen to be brought to them with their breakfast. On the units where service users have dementia it was observed that no choice was offered to them during meal times. Staff were uncertain of portion sizes with only a small amount of scampi available to service users with dementia and staff ran out of scampi, although a huge quantity was available for the younger adults, staff appear to guess what food service users prefer and there needs to be greater liaison with the kitchen. It was also noted that tables are not laid for meals and food is bought to service users with their cutlery either in the bowl or on the plate. It is also a concern that the main meal of the day is at 16.30 although there are less staff available to assist service users to eat at this time. Procedures at meal times need review to ensure that meal times are made as pleasant as possible and that have sufficient time to give assistance to those service users who require assistance. Ryland View DS0000004818.V309876.R01.S.doc Version 5.2 Page 15 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 The outcome indicator for this group of standards is judged to be adequate. The home has appropriate policies and procedures to raise concerns and protect vulnerable people. There is a need for all staff to ensure that concerns are highlighted to the appropriate people to enable them always to be appropriately acted upon and safeguard service users. EVIDENCE: The home has a detailed complaints procedure which is prominently displayed on each unit and is also included in the service user guide. The home has received eight complaints, and of which one was also sent to the Commission for Social Care and Inspection. There was a record of all complaints made directly to the Home Manager all of which had been appropriately investigated within required timescales, but further complaints were also seen within service users care records that the manager had no knowledge of and had not been appropriately investigated. The home has made two Adult Protection referrals and has undertaken all required actions undertaken to safeguard its service users. The home has appropriate policies to ensure that staff who are not suitable to work with vulnerable people do not do so by robust recruitment and selection procedures. There is a need to ensure that all staff receive training in the Protection of Vulnerable Adults to ensure that all staff are aware of what constitutes abuse and what actions they must take if any allegation of abuse is made to them. Ryland View DS0000004818.V309876.R01.S.doc Version 5.2 Page 16 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): 19,22, 26 The outcome indicator for this group of standards is judged to be adequate. The home is generally pleasant, homely and well maintained further improvements are required to make the dementia care units suitable to facilitate recognition for service users with dementia and ensure that the home is suitable for all its service users. EVIDENCE: A tour of all the units, was undertaken by both inspectors. The units are generally pleasantly decorated, clean and kept tidy. The home is generally well maintained and does have a programme of refurbishment to ensure that worn furniture and fittings are replaced. It was noted that there was no liquid soap in most of the toilets on Manby, we found a toilet leaking on Heronville, broken sink in the kitchen on Manby, this means that staff do not have a separate area in the kitchen to wash their hands. The sluice disinfector had been removed on Manby and a red plastic bag placed over the open waste pipe. On Heronville it was disappointing to see that curtains were hanging of the rails, other curtains were missing. Chairs were worn, torn and dirty. This was bought to the attention of the deputy manager at the time of the inspection, it was explained that there are plans to replace all the carpets and furniture on Ryland View DS0000004818.V309876.R01.S.doc Version 5.2 Page 17 Heronville in the near future. A switch exposing wires on Manby was left without being secured, staff had not highlighting this although it was immediately acted upon by the Deputy Home Manager. Staff must ensure that they comply with their health and safety responsibilities. Heronville has recently been redecorated but at present most of the walls are bare and provide no visual stimulation for the service users. The home has a variety of aids and adaptations such as grab rails assisted baths and a wheel in shower available for dependent service users and a full nurse call. There are a number of service users that require a considerable amount of care whilst in bed but not all service users are in a suitable bed to aid service users and staff comfort whilst care is provided in bed. A requirement was also made to ensure that service users have the required pressure relieving equipment. The home’s infection control procedures were reviewed and generally found to be satisfactory apart from issues previously identified. Ryland View DS0000004818.V309876.R01.S.doc Version 5.2 Page 18 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): 27,28,29,30 The outcome indicator for this group of standards is adequate. The number and skill mix of staff does not always meet service users needs. Staff are recruited in a safe manner and service users are safeguarded by the homes practices. EVIDENCE: Staffing levels have not changed since the previous inspection. Observations made during the inspection raised concerns about the number and skill mix of staff to care for the dependency of service users on three units: Haines, Manby and Heronville. Service users on all three units were still being got up after eleven and were then given their breakfast. This may have been the preferred choice of some service users but staff highlighted this was not the case for many service users. There was also inadequate staff available to assist with feeding of service users particularly on Heronville and Manby for both lunch and dinner. Manby had been short staffed all weekend which had also been made worse as they had had no domestic staff and care staff had also to undertake domestic duties. Night staffing levels are also a concern particularly for the dementia care units where there are just three staff between 8pm and 8am – one trained nurse and two care staff to care for thirty service users with dementia and who may have challenging needs. The home has 57 of its care staff with National Vocational level two in care which more than meets the requirement of at least 50 qualified care staff. Ryland View DS0000004818.V309876.R01.S.doc Version 5.2 Page 19 Staff files seen and generally contained all of the required information only minor improvements being required to meet the minimum standards. Staff are recruited in a safe manner and service users are safeguarded by the homes practices. The unit managers are responsible for the induction of new members of staff, generally records were incomplete and did not show that new workers were being appropriately supervised when they begin work. Similarly there were gaps in training for existing staff that must be addressed to ensure that their knowledge and skills are regularly updated and based upon current good practice. Ryland View DS0000004818.V309876.R01.S.doc Version 5.2 Page 20 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): 31,33,35,38 The outcome indicator for this group of standards is judged to be adequate. Managerial arrangements are generally effective but there is a need that service users are listened to and appropriate and required actions are undertaken consistently on all units. EVIDENCE: Ryland View is a site of one hundred and forty beds within five separate units. The site is managed by an experienced Home manager who is registered with the Commission for Social care. Each unit has a unit manager who is responsible to the Home Manager. Unit Managers raise concern about the lack of supernumery time when they are additional to care numbers to undertake their managerial responsibilities. Weaknesses in management was highlighted primarily on two units- Heronville and Manby. Ryland View DS0000004818.V309876.R01.S.doc Version 5.2 Page 21 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 with an action plan identified to address issues raised.. 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. 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. The home has good health and safety advice and support with specialist advice available from within the company. The home complies with health and safety legislation, although records did show occasions that staff do not always undertake required actions when issues of health and safety are identified complaints were made about paving slabs outside Heronville that had poised a tripping hazard although it was only when a second visitor had fallen that funding was agreed and the slabs levelled. Staff had also failed to inform the Commission for Social Care Inspection of notifiable incidents such incidents of violence and aggression between service users and when a service user had absconded. Maintenance records were seen and were in good order. Fire safety training must be improved so that all staff are receiving training at least once a year. Most of the units participated in fire drills recently with the exception of unit that failed to undertake required actions within an acceptable timescale. There must also be an improvement in the mandatory training of staff to include infection control, first aid and food hygiene. All accidents are recorded and reported as expected Ryland View DS0000004818.V309876.R01.S.doc Version 5.2 Page 22 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 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 2 2 x x 2 x x x 2 STAFFING Standard No Score 27 1 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 x 3 x x 2 Ryland View DS0000004818.V309876.R01.S.doc Version 5.2 Page 23 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. The home generally meets this requirement all service users have a pre admission assessment but this is not always fully completed. This requirement was made at the inspection undertaken in September 2002 All staff working on the dementia care units must have training in dementia care and behaviour that challenges. Care plans must be person centred and not task orientated. The service user and or their relative’s representatives are involved with the drawing up of the care plan and sign to confirm DS0000004818.V309876.R01.S.doc Timescale for action 31/10/06 OP4 2 3 4 OP7 OP7 18 31/12/06 15 15 31/10/06 31/10/06 Ryland View Version 5.2 Page 24 this and their agreement with the care plan. The residents social care needs are identified in the care plan. Partially met. This requirement was made at the inspection undertaken in September 2002 5 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. All service users on Manby have an accurate nutritional risk assessment that meets their needs.- This was an immediate requirement made during the inspection. The risk of pressure sores must be reduced: All service users must have required pressure relieving equipment as identified by their pressure risk assessment. immediate requirement made during the inspection Pressure relieving equipment must be used as the manufacturers guidelines and at the required pressure setting. Further development in activities is also required for those service users with dementia. Staff must have training in use and types of pressure relieving equipment. The registered manager must ensure that all bed rail risk assessments are reviewed and that this is documented. Staff must have guidance on how to complete the bed rail risk Ryland View DS0000004818.V309876.R01.S.doc Version 5.2 Page 25 31/10/06 6 OP8 15 14/09/06 7 OP8 13(4)(c) 31/10/06 8 OP7 13 (7) 31/10/06 9 OP9 13(2) assessments. There must be no gaps on the Medication Administration Record. All omissions in medication must be accounted forThe administration of creams and lotions must be recorded. The treatment room temperatures must be under 26 degrees Celsius at all times. 31/12/06 10 OP10 12 (4)(a) 11 OP10 16 (2) (c) 12 OP12 16(2)(n) The date of opening of short life items (calgen) must be recorded. The registered manager must 15/10/06 ensure that all service users are treated in a manner that respects their dignity at all times. The registered manager must 15/10/06 provide screening to avoid service users dignity being compromised when they are using the hoist. The home must ensure that all 31/10/06 service users have the opportunity to engage in activity regardless of their illness. There must be a review of the type of activity service users with dementia are engaged in Procedures at meal times must be reviewed to ensure that meal times are made as pleasant as possible and that sufficient staff are available to assist service users. All concerns and complaints must be appropriately recorded and acted upon. Required procedures must be reinforced with all staff. All staff must receive training in what constitutes abuse and DS0000004818.V309876.R01.S.doc 13 OP15 16(2)(i) 31/10/06 14 OP16 22(3) 15/10/06 15 OP18 13(6) 31/12/06 Page 26 Ryland View Version 5.2 16 OP19 16(2) (k) 23 (2) (k) required actions to be made is allegations are made to them The offensive odour when entering Heronville unit must be eradicated. The registered person must ensure that curtains are replaced and repaired on Heronville unit. The leaking toilet on Heronville must be repaired. The hand washing basin on Manby unit (kitchen) must be repaired to enable staff to wash their hands. The waste pipe on Manby covered with a red plastic bag must be addressed so that the offensive odour is eradicated and the pipe is made safe. 15/10/06 17 OP22 23(2)(n) 18 OP27 18(1) 19 20 21 OP30 OP36 OP38 18 18 23(4)(e) Service users requiring a considerable amount of care whilst in bed must have a suitable bed that is height adjustable. The number and skill mix of staff to meet service users needs and dependency is reviewed for each unit. New staff must have induction training to the required standard within required timescales. All care staff must have formal and recorded supervision at least bi monthly. The registered manager must ensure that all staff take part in fire drills and are aware of the procedure to be followed in the event of a fire. The registered manager must ensure that all staff receive required mandatory training 31/10/06 31/10/06 31/12/06 30/11/06 15/10/06 Ryland View DS0000004818.V309876.R01.S.doc Version 5.2 Page 27 22 OP38 37 The registered manager must ensure that the Commission for Social care and Inspection is informed of all incidents that affect service users health, safety and well being. 10/10/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP12 Good Practice Recommendations Activities for service users with dementia are further developed. Ryland View DS0000004818.V309876.R01.S.doc Version 5.2 Page 28 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.V309876.R01.S.doc Version 5.2 Page 29 - 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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