Inspection on 25/06/07 for Ryland View

This inspection was carried out on 25th June 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

Ryland View 27/08/09

Ryland View 28/05/09

Ryland View 25/11/08

Ryland View 11/09/06

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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Maple Lodge

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 Mandy Beck Key Unannounced Inspection 09:00 25 and 26th June 2007 th 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.V337463.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.V337463.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.V337463.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 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. 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. 11th September 2006 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.V337463.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 toiletries, hairdressing, chiropody and newspapers. Ryland View DS0000004818.V337463.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 over a period of two days. We have used a variety of methods to collect information about the home and the service it provides. We spent time during the inspection talking to the manager, staff and service users. We also looked at service users files as part of our case tracking process. This enables us to make decisions about whether the home is meeting service users needs. Staff files were examined to make sure the home is continuing to recruit people in a way that safeguards service users and to ensure that all staff are receiving the required training. We have also included in this report comments from service users who completed our questionnaires. The manager has also supplied us with information about the service they provide in their Annual Quality Assurance Assessment (AQAA). All of the above has been used to help us make judgments in this report. Both inspectors would like to thank the manager, staff and service users for their hospitality throughout this inspection. What the service does well: Each of the units at Ryland View has it’s own activity therapist who works with service users to help keep them engaged in their environment and hobbies and other interests. Activity programmes are kept under review and can be amended to meet service users changing needs. The home has good systems in place to deal with complaints or concerns raised by service users and their families. The manager is competent and service users can expect that each issue that is raised will be addressed in a professional manner. Each of the units is relaxing and service users state that they are happy living there. “it’s beautiful isn’t it they try really hard to keep it all clean for us”. All of the service users we spoke to said that the staff were “wonderful”, “golden couldn’t ask for better”. “speaking on behalf of my father the care at Ryland View is exemplary”, “the staff take care of his every need and want Ryland View DS0000004818.V337463.R01.S.doc Version 5.2 Page 7 with dignity and the care staff always make visitors feel welcome at the home too”. Everyone we spoke to said that the meals provided by the home are excellent. There is plenty of choice available and the chef is able to cater for any dietary requirements. What has improved since the last inspection? What they could do better: Service users do not receive a statement of terms and conditions when they move into the home unless they are privately funded. It is acknowledged that contracts are given to service users from the funding authority but the home must consider giving all service users a statement of the terms and conditions of their residency. This will clearly set out what is included in the fee, the role Ryland View DS0000004818.V337463.R01.S.doc Version 5.2 Page 8 and responsibility of the provide and the rights and obligations of the individual. To avoid an unnecessary tissue damage the home must ensure that all air flow electric mattresses are set to the correct pressure for each individual service user who requires one. There must also be systems in place for the speedy replacement of these mattresses if they break and require repair. The home needs to continue to improve the way in which it notifies the CSCI of incidents that affect the well being of its service users. They will need to do this using the Regulation 37 notifications. Service users have said “you do receive the basic care but can be lacking when individual care is needed, everyone is treated the same way which is not always right” “the gardens could be really nice if tended more but you seem to have to complain before the grass gets cut and the borders are tidied”. “I think they should have a little more of a social life and people to talk to and listen to them more and give them some therapy to save them getting bored” The service users on Palethorpe should be consulted about the provision of more community based activities to help keep them active within the community and to maintain links with it. Staff who work on Palethorpe unit should be given training mental health issues and alcohol related dementia. This will give them a more in depth understanding of the health issues some of the service users have. 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. Ryland View DS0000004818.V337463.R01.S.doc Version 5.2 Page 9 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.V337463.R01.S.doc Version 5.2 Page 10 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): 1,2,3,4,5 Quality in this outcome area is good. Prospective service users are given sufficient information to enable them to make a decision about living at the home. They can feel confident that their needs will be assessed in full and that the home can meet them. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has recently updated its Statement of Purpose and it is available on request from the main office. In addition to this prospective service users are given copies of BUPA publications “Home Front” and “Choosing a Care Home”. All of these documents give prospective service users good sources of information on which to base a decision about moving into the home. Contracts were not available for all service users and in some cases had not been updated since they first came to live at the home, one service users contract was dated 1996. One service users record contained a letter agreeing to a payment of “£630 per week and £20 for social outings and £10 for Ryland View DS0000004818.V337463.R01.S.doc Version 5.2 Page 11 continence products but there were no contract or terms and conditions of residency. There were other contracts that did not clearly identify whether the free nursing care contribution is in addition to the fee. At present only those service users who are privately funded receive terms and conditions of residency. This was discussed with the manager during the inspection and was suggested that all service users should receive terms and conditions so that they are all aware of the conditions of their residency regardless of who is paying their fees. Service users also need to be aware of the role and responsibility of the provider (BUPA) and of their individual rights and obligations whilst living at the home. All service users have a detailed assessment of their needs prior to them coming to live at the home. Records seen show that whenever possible the service user or their representatives are involved in the assessment of need. BUPA has now introduced the QUEST system. The system enables both staff and service users to take part in the assessment of their needs. Throughout the document there are prompts for staff to complete risk assessments and care plans once an area of need has been identified. Staff said “its been a lot of hard work but you can see how it works now”, “its made us look again at the residents and how they have their needs met” Care Programme Approach (CPA) documentation was not available for a number of residents despite these residents having mental illness. These should be available so that staff are aware of triggers that show deteriorating mental health and actions to be taken. There was also little evidence that these service users had had a review of their care needs by the mental health team. Some service users are very ill and are transferred from the hospital for palliative care. When this happens service users care needs are discussed with other health care professionals over the telephone to ensure that the home will be able to meet their needs and have appropriate equipment available for them. A more detailed assessment is then undertaken when they arrive at Bloomfield unit. During their stay on Bloomfield unit the service users will remain a hospital patient and have their hospital notes during their stay at Bloomfield. Bloomfield unit has 10 terminal illness beds. And 16 continuing care beds funded by the Primary Care Trust (PCT). A doctor visits the unit 4 days a week and one day a week a consultant visits. The unit also has close contact with the Macmillan nursing service. Training records identified that all but very recent staff had had training in palliative care and terminal illness with the majority of staff having several updates each year, with in-house education training sessions given to them by Macmillan Nurses. It was evident during the visit to Palethorpe unit that a number of service users had needs outside of the homes categories of registration. Several Ryland View DS0000004818.V337463.R01.S.doc Version 5.2 Page 12 service users primary needs were mental illness including alcohol related dementia, early onset dementia, schizo affective disorder and learning disability. Although some service users had lived on Palethorpe for sometime others had only recently been admitted in the last few months. The registration categories of the home need to be reviewed to ensure that the home is not breaching its registration. When staff on Palethorpe were asked about their knowledge and whether they had had any training in conditions such as dementia, depression and other mental health conditions that affected their service users, they said that they had not had any and were not aware of how these conditions would affect their service users. Another service user was funded to receive one to one care for 6 hours a day but when staff were asked how they gave one to one care to the service user they said “ we talk to him when we feed and toilet him”. The unit manager said that staff usually provide one to one care for an hour in the afternoon, an hour in the evening and when it was quiet sometimes in an evening and the Activity Organiser also gave this service user time on a one to one basis but this did not appear to any different to the other service users. The home also provides specialist dementia care. It was pleasing to see that on both Heronville and Manby unit there had been much improvement since the last inspection. Staff said “we had training, which was good because I came back to the unit and was ready to make things better”. “We are trying hard to make it better we’re doing a sensory room and we’ve had it decorated”, “the training was good but we could do with some more practical training like challenging behaviour”. Ryland View DS0000004818.V337463.R01.S.doc Version 5.2 Page 13 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): 7,8,9,10 Quality in this outcome area is adequate. People who use this service have access to health care services. Their health needs are monitored and appropriate action taken. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We used the case tracking process to look at the care of 13 service users from across the site. The implementation of the “QUEST” care documentation has been very positive. All care plans seen provided comprehensive care instructions, were person focused, and were regularly reviewed. They also had required risk assessments such as pressure sore risk, nutritional risk, falls and the use of bed rails. Care plans seen were person centred in their approach for instance one care plan addressed one service users eating and drinking problems, the plan was concise but detailed all of the individual care that this service user required. Other care plans addressed service users challenging behaviour, the plan was descriptive and gave staff clear instructions on how to manage this behaviour. Ryland View DS0000004818.V337463.R01.S.doc Version 5.2 Page 14 There are improvements that need to be made for instance one service user had been admitted to the home with MRSA, when we looked in her noted we saw that there was no care plan instructing staff how to manage this and precautions that they need to take to prevent the MRSA from spreading. During the last inspection concerns were raised about the availability of pressure relieving equipment for service users. It was pleasing to see that the home has recently purchased 50 soft foam pressure reducing mattresses, and a further supply of electric air mattresses were delivered on the first day of this inspection. This will help reduce the potential of pressure damage to service users. Some staff reported that at times when electric air flow mattresses break down there could be a delay in supplying a new one. When this happens staff use an alternative soft foam mattress until the electric mattress can be either replaced or repaired. This is not an ideal situation and the manager must ensure that at all times service users have the equipment they require to meet their needs. We also found that other electric mattresses were set at the incorrect setting making them too hard and which would compromise their effectiveness and place service users at increased risk of developing pressure sores. The manager was informed of this during the inspection and has agreed to take action to rectify this. This was raised during the last inspection where the home was given a letter of serious concerns asking them to address this problem. All service users are seen regularly by their GP and there is evidence to show that other community professionals visit the home upon request. Medication practices across all of the units are generally satisfactory. There are photographs of all service users to provide a check that the member of staff is giving the medicine to the right service user. Staff record the drugs fridge temperature daily but all drugs fridges were recording temperatures which would be unsafe to store medicines. Manby had twelve days in the month when the drugs fridge temperature was below safe guidelines with several days it was recorded as low as –4oC which would cause the medicines including insulin to freeze and reduce its effectiveness. Manby does record the temperature of the room where medicines are stored and although the other units do check this temperature it is not always recorded. This was bought to the attention of the manager during the inspection and suggested that new fridges were obtained for each unit to ensure that those medicines that require cold storage are kept at recommended temperatures and service user are not place at risk. Some of the units are not retaining service users medication for the required 7 day period following their death. Ryland View DS0000004818.V337463.R01.S.doc Version 5.2 Page 15 Staff continue not to record the administration of creams although the Quality Manager is asking for clarification from the CSCI that it is acceptable not to sign for some creams as these are administered by the care staff who are not allowed under BUPA policy to sign the medication record. Staff must also make sure that they are recording when service users take their dietary supplements this will help provide an accurate record of the supplements each service user has taken. It was pleasing that drugs assessments of all staff have commenced with the majority of Manby staff already receiving this training. This process will help to identify those staff who need more support when administering medication and also shows those members of staff who are competent in administration of medication. The home has good systems for the management of controlled drugs with a hand over of all controlled drugs checked between days and night staff twice a day. There is a homely remedy policy further advice from CSCI Pharmacist recommends that the home contacts their pharmacy who will have a list of current medicines and so would be able to advise staff if it was safe to give the homely remedy with other medicines that they have. There was good interaction between service users and staff on all units visited. Staff were careful to preserve residents dignity ensuring they were covered by a blanket when they were moved in the hoist. Staff were also seen to knock on toilet and bathroom doors before opening them. We recommend that signs are put on doors that staff can move to say whether or not the toilet or bathroom is occupied. One area where staff need to develop a greater understanding is the expression of sexuality. We found that one service user was regularly noted to be missing his wife’s company, staff had recorded in the daily notes that “sometimes he fidgets with his private parts when is his in his room to show that he knows what he is doing as soon as one of the staff enter the room he stops”. When talking to staff there was little recognition of this service users sexual needs or that this may be his way of dealing with the situation he finds himself in. This should be addressed by the manager to ensure that all staff are aware of service user need to express themselves sexually. Ryland View DS0000004818.V337463.R01.S.doc Version 5.2 Page 16 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): 12,13,14,15 Quality in this outcome area is good/adequate People who use this service have an excellent choice of menu and can feel confident their dietary needs will be met. The home needs to further develop the activity provision for the people who live in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Service users said that they were looking forward to their summer fayre which was planned the weekend after the inspection after having previously been cancelled due to bad weather. Each service user is asked about their likes and dislikes during their assessment on admission. Some of the units had developed care plans that addressed the social needs of their service users. There are activity therapists on all units who work with service users ensuring that they are stimulated and taking part in activity. Service users said that they had a choice of how they spend their days such as when they get up and go to bed, and when they have their meals and what they have to eat. Ryland View DS0000004818.V337463.R01.S.doc Version 5.2 Page 17 Palethorpe unit specialises in the care of the younger adults with neurological disorders. We found that many of the service users are active and able to leave the unit but the activity provision was not really focussed on community inclusion. We found that some service users are taken out to the shops occasionally but other activities such as trips and holidays are not taking place. Some service users do go out to different services like Cross roads and the manager did say that staff take them out shopping although this was not seen in the files that we looked at. Staff said that it was difficult to take them out without their own transport. When we discussed this with the manager she said that it was “BUPA policy not to provide a minibus as it was expensive and required considerable running costs” which will be a disappointment to service users and staff who feel that it will enhance residents life at the home if they could go out more frequently. Visitors spoken to said that staff are “very good, do their best and always make them welcome”, “my father’s care is exemplary”, “my relative is always cared for with dignity and respect better still we are always made to feel very welcome when we visit”. The home does have an extensive menu and service users said that food “is very good and there is plenty of choice”. There is a daily choice of six meals. Following the last inspection the cook has worked hard to improve the meal provision for service users. Each service user is able to choose a hot meal both at lunch and dinnertime; there is a lighter meal at the lunchtime and a more substantial meal in the evening. If service user wish they can have three cooked meals a day. It was lovely to see that service users had no less that seven different types of meals being served to them. On the day of this inspection the choices ranged from pizza and curly fires, egg and chips, beef steak, lamb chops, chicken breast and cheese and potato pie. Vegetables were also available we saw broccoli, sweetcorn, beans, and baked beans. It was pleasing to see that all service users were given a choice about having gravy put on to their meals rather than just routinely added. A small sample of each was tasted once the service users had been served. All the food was tasty and hot but we were most impressed by the choices given As a result of this change in menu and meal times staff reported that service users are gaining weight and enjoying their food much more. Staff should be congratulated on their hard work in improving the nutritional intake and choice for the service users. Ryland View DS0000004818.V337463.R01.S.doc Version 5.2 Page 18 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): 16,18 Quality in this outcome area is good. Service users can feel confident that their views and concerns will be listened to and acted upon. The home has good systems in place to be able to protect service users from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a comprehensive system in place for dealing with service users concerns and complaints. The manager investigates all concerns and keeps a clear record of them, recording outcomes and service users satisfaction. After discussion with the deputy manager there are also plans to begin recording all verbal complaints rather than just written ones as is the current system. All of the service users who completed our questionnaire indicated that they were aware of how to make complaints if they needed to and they felt confident that they would be handled in a professional manner. 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. Staff have received training in the Protection of Vulnerable Adults. Staff spoken had appropriate knowledge of what is abuse and what actions they must take if any allegation of abuse is made to them. Ryland View DS0000004818.V337463.R01.S.doc Version 5.2 Page 19 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): 19,26 Quality in this outcome area is adequate. The people who use this service live in a comfortable home that is generally clean and tidy. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We visited all of the units and were pleased to see that some improvements have been made to all of them. Most pleasing was Heronville, there have been some significant changes since the last inspection. The lounge and dining area have been rearranged to enable to service users to access the dining table more freely. The whole area has been redecorated and new furniture has been supplied. The unit felt much more relaxed and service users appeared to be enjoying their surroundings. On Manby unit the manager was busy with the activity therapist planning a sensory area in the lounge. This will enable service users to access it at Ryland View DS0000004818.V337463.R01.S.doc Version 5.2 Page 20 anytime and enjoy a relaxing and peaceful environment. The general atmosphere on this unit was also relaxing. Bloomfield unit has been redecorated although the majority of the bedrooms remain as they were when the home was first opened with the decoration “faded and tired”. The lounge on Haines was decorated about eighteen months ago although more bedrooms have been decorated, carpets are marked and stained and the general impression that it looks dark and gloomy. Staff said “we are always the last they seem to refurbish the other units but forget about us, I wish you would do something about the carpets they just look so awful”. Some of the service users commented “sometimes the home can be a bit smelly but they do their best. There is a lot of incontinence perhaps if they installed air conditioning it would help this”, “the gardens could be rally nice if tended but you seem to have to complain before the grass gets cut and borders tidied”. “my relative has been there for 12 year and she still has the same wallpaper her furniture is looking knocked about now as well”. One service user commented that “there appears to be a vermin problem around the grounds of Bloomfield”. This was raised with the manager who confirmed that there had been a problem but the home had taken appropriate steps with pest control to address this. The AQAA document clearly states that the plan for improvement over the next 12 months will be to “have a refurbishment programme in place and will continue to upgrade the facilities as funds allow”. Part of this refurbishment plan means that Palethorpe unit is next for redecoration and upgrades. We found throughout the home that there is a satisfactory supply of gloves and aprons and liquid soap. These items will help to reduce the risk of cross infection to service users. we observed staff changing their aprons after they had completed personal care with service users and before they served meals. we also observed that before staff served food to service user not all of them had washed their hands. This is an area for further improvement in order to keep service users risk of cross infection to a minimum. Ryland View DS0000004818.V337463.R01.S.doc Version 5.2 Page 21 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): 27,28,29,30 Quality in this outcome area is good. People who use this service can have confidence in the staff who look after them. New staff are recruited in a manner that safeguards service users interests. Staff are qualified and competent to meet the needs of service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There are sufficient numbers of staff on each unit of the home to meet service users needs. Service users we spoke to said “they are golden you know and really try to help”, “sometimes they make us wait for the toilet but you can understand it if we all want to go at the same time”. Some of the staff on Haines unit raised concerns about the dependency of their service users saying they do not have chance to “chat with residents” as they don’t stop getting them up until 11.45am by which time it is time to start doing the next “ round of toileting”. Staff also said that they were not allowed to use agency and frequently worked short of staff. The Manager agreed that they was a staff sickness issue on Haines which they were not managing effectively and that they only worked short when absence was last minute and it could not be covered by bank, agency or existing staff. Ryland View DS0000004818.V337463.R01.S.doc Version 5.2 Page 22 The manager has also indicated in the AQAA that over the next twelve months there will be a focus on the management of unauthorised absences. This should mean that staffing levels will become more stable and service users will benefit from the consistency this will bring. The deputy manager has been improving the systems for mandatory training in the home. All staff are now attending regular training session ensuring that their knowledge and skills are being kept up to date. The home must however improve on the numbers of care staff who have a National Vocational Qualification (NVQ). At present only 24 out of 109 care staff have obtained this qualification. There are a further 25 care staff who are working towards this at present. We looked at the staff files for 6 members of staff. We did this to ensure that the home is continuing to recruit people in a way that safeguards service users. The home has also introduced a new system making all staff file easier to navigate and information finding easier. It was pleasing to see that all of the files seen were up to date and contained all of the required information. All new starters are given a personal best folder which contains all of the induction standards. New workers are supported on the units by senior carers or trained nurses. Ryland View DS0000004818.V337463.R01.S.doc Version 5.2 Page 23 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): 31,33,35,38 Quality in this outcome area is good. People who use this service can be confident that it is managed well and the home is run in service users best interests. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home continues to be managed well by Mrs Laura Williams. Since the last inspection two new unit managers have taken up post on Heronville and Manby units. It was pleasing to find that on both of these units there has been much improvement and service users are benefiting from strong leadership on both of them. The manager is supported in her work by a deputy manager and five unit managers. Ryland View DS0000004818.V337463.R01.S.doc Version 5.2 Page 24 The home does have a quality plan, which reviews all areas of the home at least annually. The home manager conducts monthly audits of the incidence of pressure sores and care plans and quarterly audits of accidents and complaints. A service user surveys are undertaken annually. A report is available of the findings of previous surveys. Staff can be rewarded customer service awards with “Personal Best Awards” which are nominated by services users or relatives for care beyond expectations and it was lovely to see a number of staff were proudly wearing their badges. Secure facilities are available for the safe keeping of service users personal money and valuables. Written records are available for all transactions and detail the reason for the withdrawal and two signatures. Regular external audits of service users personal money are undertaken. The home support services users to manager their own finances if they want to, but the majority of services users have their finances managed by their families or by a appointeeship. Staff do not manage service users financial affairs as required by the regulations to safeguard services users financial interests. Service users cannot access their own money at weekends so a little forward planning may be necessary. The administrator did explain that if the situation arose the unit managers have usually lent the money to service users and have been reimbursed on Mondays as soon as she is in the office. The home has good statutory training opportunities for fire safety training, moving and handling, infection control, the protection of vulnerable adults, first aid and health and safety. Procedures to protect service users include regular checks on the fire alarm, emergency lighting, fire extinguishers, nurse call points and hot water. The home has consistently demonstrated appropriate health and safety with support provided and audits undertaken by head office. The Manager confirmed that maintenance records and contracts were up to date. The manager must improve the reporting of events to the CSCI under Regulation 37, we found evidence of service users having been admitted to hospital, falls and incidents of aggression between service users that we had not been notified of. Ryland View DS0000004818.V337463.R01.S.doc Version 5.2 Page 25 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 3 2 3 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Ryland View DS0000004818.V337463.R01.S.doc Version 5.2 Page 26 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 OP8 Regulation 13(4)(c) Requirement The risk of pressure sores to service users must be reduced: Pressure relieving equipment must be used as the manufacturers guidelines and at the required pressure setting. Staff must have training in use and types of pressure relieving equipment. (previous timescale of 31/10/06 not met) 2 OP9 13(2) 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. (previous timescale of 31/12/06 not met) 3 OP9 13(2) Service user medication that DS0000004818.V337463.R01.S.doc Timescale for action 30/07/07 30/07/07 30/07/07 Version 5.2 Page 27 Ryland View 3 OP38 37 requires cold storage must be kept at recommended temperatures to avoid damaging their medication and placing them at risk. 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. (Immediate requirement 12/09/06. previous timescale of 10/10/06 not met) 30/07/07 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 OP2 Good Practice Recommendations Each service user is given a statement of terms and conditions detailing their fees, the provider responsibilities and their right and obligations whilst they are resident at Ryland View. Greater numbers of staff on Palethorpe unit would benefit from further training in alcohol related dementia, mental health issues and learning disability. This will give service users greater confidence in knowing that staff can recognise and understand their needs. Service users on Palethorpe should be consulted about the type of activity they would like to be involved in outside of the home. The home should make arrangements to support service user to do this. It is recommended that the home obtain a copy of the Department of Health guidance “Mental Capacity Act 2005 core training set” published July 2007 It is recommended that the home obtain a copy of the Department of Health guidance “Mental Capacity Act 2005 residential accommodation” published July 2007 DS0000004818.V337463.R01.S.doc Version 5.2 Page 28 2 OP4 3 OP12 4 5 OP14 OP14 Ryland View 6 OP22 The home must consider the provision of spare electric pressure relieving mattress so that service users experience no loss of equipment whilst their mattress is being repaired. Ryland View DS0000004818.V337463.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Halesowen Local Office West Point Mucklow Office Park Mucklow Hill Halesowen B62 8DA 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 Ryland View DS0000004818.V337463.R01.S.doc Version 5.2 Page 30 - 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. 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