Inspection on 28/11/05 for Rylands

This inspection was carried out on 28th November 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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

Rylands 22/11/06

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Westmead

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

CARE HOMES FOR OLDER PEOPLE Rylands 74 Forton Road Newport Shropshire TF10 8BT Lead Inspector Pat Scott Announced Inspection 28th November 2005 09:30 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 Rylands DS0000064650.V256333.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Rylands DS0000064650.V256333.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Rylands Address 74 Forton Road Newport Shropshire TF10 8BT 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) 01952 814871 01952 825536 Rylands Care Limited Tracie Deborah Peate Care Home 34 Category(ies) of Old age, not falling within any other category registration, with number (34) of places Rylands DS0000064650.V256333.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home must provide the following minimum staffing levels for 34 service users: 8am-2pm - 2 RNs and 6 Care Assistants: 2pm-8pm - 2 RNs and 6 Care Assistants: 8pm-8am - 1 RN and 3 Care Assistants. These are minimum levels required throughout the 24hr day, including weekends, for service users who have low to medium dependency nursing needs. Additional staff must be on duty when high dependency service users are accommodated. These minimum levels are for direct nursing and personal care only. They do not include ancillary staff. They are exclusive of the manager`s time. 5th July 2005 Date of last inspection Brief Description of the Service: The Rylands is a care home offering both personal and nursing care to older people. The Home is registered to provide care for a maximum of 34, of which up-to 17 may require nursing care with the remaining 17 requiring personal care and accommodation. Rylands is owned by Rylands Care Limited, the Responsible Individual being Dr Mark Cowling and the Manager is MsTracie Peate. The Home is a large, converted country house with accommodation provided on three floors. Communal lounges and dining rooms are situated on the ground floor with bedrooms on all three floors. Residents requiring nursing care are usually accommodated on the ground floor, although those who are sufficiently mobile may have a room on the first floor. The two upper floors are accessed via a shaft lift or stairs. The gardens are well kept and accessible to the Residents. Rylands DS0000064650.V256333.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection took place on the 28th November 2005 commencing at 10.00am for the duration of 4 hours by two inspectors. The National Minimum Standards for Care Homes for Older People focus on achievable outcomes for service users – that is the impact on the individual of the facilities and services of the home. Evidence was looked for that the standards were being met and a good quality of life enjoyed by service users through: • Discussions with service users, families and friends, staff and managers. • Observation of daily life in the home • Scrutiny of written records (including care plans for 4 service users). The statement of purpose was used to assess how far the home’s claims to be able to meet service user requirements and expectations were being fulfilled. Reports regarding an overview of the conduct of the home are sent to CSCI on a monthly basis. These, as well as the risk assessment from the last inspection were taken into account to determine the core standards focused on and depth of inspection. What the service does well: There is a clear commitment from the new owners to maintain a good service at the Rylands and improve it further. The quality of care provided in this care home is strongly influenced by the calibre of the registered manager, who is supernumerary, and her relationship with the owners which fosters an atmosphere of openness and respect. All levels of staff are very well trained which is reflected in the team spirit and outcomes of care seen at this inspection. The manager undertakes her responsibilities in a thorough manner. Her record keeping as required under the Care Homes Regulations 2001 is excellent. Service users spoken with stated that the home continued to be a happy place to live and the day-to-day dealing with management was very good. Rylands DS0000064650.V256333.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? 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. Rylands DS0000064650.V256333.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Rylands DS0000064650.V256333.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,4,5 The information that the home provides is to be improved so that prospective service users can make an informed decision about admission to the home. The recording of assessment of need is good ensuring that service users who move into the home are assured that their needs will be met. EVIDENCE: The home has a statement of purpose, the content of which is largely carried over from the previous owners of the home. It is poorly presented and could be made more reader friendly. It is the intention of the home in the future to apply for registration to admit service users requiring specific end of life palliative care. The manager will then explain in this document how they provide such care. Service user views about the home are also to be included. There has been an improvement in the recording of risk assessments since the last inspection. From observation, service user comments and talking to staff in the home it is evident that the home does meet the needs of service users accommodated. Rylands DS0000064650.V256333.R01.S.doc Version 5.0 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,10,11 The care planning system is in a format that provides staff with the information they need to satisfactorily meet service users needs. The health needs of service users are well met with evidence of good multi disciplinary working taking place on a regular basis. Personal support in this home is offered in such a way as to promote and protect service users privacy, dignity and independence. EVIDENCE: Care plans seen as part of the case tracking process are good. The deputy manager stated that the presentation is being addressed as they wish to record details in individual files that are already used for service users admitted for interim care. It is considered that this will be an improvement on the current standex system. Clinical nursing care for all service users is provided in a sensitive, tactful manner. Care plans detailed communication between other health care professionals. It is the intention of the manager to implement a document Rylands DS0000064650.V256333.R01.S.doc Version 5.0 Page 10 called the ‘Liverpool care pathway’ which is more specific to end of life care. This would be used in the last days or hours of life and would demonstrate the homes commitment to improvement in clinical practice. Standard 11 would be exceeded if this intention were put into practice once registration for terminal care has been approved. Written service user comments received at and after the inspection included: “Waited on hand and foot”. “Loving caring help”. “Happy to come back”. Rylands DS0000064650.V256333.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Dietary needs of service users are well catered for with a balanced and varied selection of food available that meets service users tastes and choices. Staff have an excellent understanding of the service users support and leisure needs and use this to assist them to exercise choice and control in their lives. EVIDENCE: The ‘friends of the Rylands’ provides a diary of planned events. Other events to be taking place are displayed around the home. Sight of these shows that a varied amount of events take place. Service user comments were that they felt their recreational preferences were being addressed and that they were tailored to individual needs. The service users at The Rylands have very individual lifestyles and interests and the pre-inspection comments noted that they were satisfied with the leisure opportunities on offer to be enjoyed. This was also reflected in the way they could personalise their rooms, have contact with family and the choice available for meals. The new menus seen showed that nutritious food is provided. The majority of the respondents to the questionnaires ticked the ‘yes’ or ‘sometimes’ column about whether they liked the food. Fresh fruit is served at the afternoon tea Rylands DS0000064650.V256333.R01.S.doc Version 5.0 Page 12 rounds as a result of comments from a service user at the client focus meeting of 7.9.05. Menus and food are regular items on the agenda at these meetings and it is considered that service users are able to voice their opinions in an open way. Rylands DS0000064650.V256333.R01.S.doc Version 5.0 Page 13 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 home has a satisfactory complaints system with evidence from service users comments that they feel their views are listened to and acted upon. Staff have been provided with induction and on-going training regarding adult protection. This provides staff with the relevant knowledge to safeguard service users from many types of abuse. EVIDENCE: There have been no formal complaints received. Service users comments were that they would be happy to talk to Matron or the Owners about any concerns they would have. The manager has completed the train the trainers course in adult protection. Staff files showed that adult protection had been addressed at induction and on going training. Staff spoken with confirmed that this has occurred. Rylands DS0000064650.V256333.R01.S.doc Version 5.0 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,22,23,24,25,26 The standard of décor within this home is very good with evidence of improvement through maintenance and future planning. The home, therefore, presents as a homely and comfortable environment for service users. EVIDENCE: The standard of hygiene and cleanliness in the home is excellent. Service users praised the level of domestic input and there were no odours in any part of the premises. Rooms entered into were personalised according to the occupant’s wishes. Equipment is in place to meet the varying needs of service users within the categories the home is registered for. Rylands DS0000064650.V256333.R01.S.doc Version 5.0 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,29,30 The home employes an enthusiastic long-serving workforce that works positively with service users to improve their whole quality of life. The home’s procedures provide a safe framework for the recruitment of staff which is followed consistently in order to protect service users. Staff are provided with training relevant to their job roles to ensure that service users assessed needs are addressed and that they are not put at risk EVIDENCE: Staff spoken to were very positive about the support from senior management. They are supported to undertake NVQ and a variety of other training. The preinspection information detailed planned training is to focus on audit research, safe handling of medicines and palliative care. The home employes 8 NVQ2 staff with 7 staff currently on the course. The home hopes to achieve the 50 ratio within 2005 or soon after. Staff are well trained with evidence of this seen on staff files. The national minimum standards refer to staff training portfolios and evidence that induction; training, supervision and appraisals are carried out. This was all recorded in the staff files sampled. Rylands DS0000064650.V256333.R01.S.doc Version 5.0 Page 16 4 staff recruitment files were seen of recent employees. All required checks were in place that demonstrated the home’s vetting procedures were thorough. Rylands DS0000064650.V256333.R01.S.doc Version 5.0 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,36,37,38 Staff are appropriately supervised which has a positive impact on the standard and consistency of care provided within the home. The manager has an understanding of the direction in which the home is going to improve. The directors have plans of how this improvement will be resourced and managed so that service users will be assured that the home has a viable future. Service users views have been sought and they perceive them as having an effect in changing how the home is run EVIDENCE: The manager has completed the registered managers award and her hours are supernumerary in the home. The manager and owners set the tone and style of the home in terms of its efficiency, probity, concern for service users and staff and its relationships with the outside world. Good management can have Rylands DS0000064650.V256333.R01.S.doc Version 5.0 Page 18 a major impact on the way care is delivered and the National Minimum Standards that are achieved or exceeded. Ms Peate and the Proprietors’ drive and enthusiasm and evidence at this inspection have clearly demonstrated this. Supervision takes place during the working shift and on a formal one to one basis. There has been a commitment to this process to ensure that training, when provided and the care planning process come together to improve outcomes for service users. The pre inspection questionnaire detailed the maintenance checks that are carried out such as fire, hot water, electrical testing etc. A sample of these was examined and all were in order. The regulation 26 reports that are sent to the CSCI each month provide the Commission with the management’s overview of the conduct of the home. It was reported by the owner that further quality monitoring is to be introduced and the results from the surveys to be added to the service users guide. Client focus meetings take place whereby comments are acted upon. This was confirmed by service users spoken with. The minutes of these were read from September to November 2005. Issues raised had been acted upon with a commitment to meeting service users preferences and wishes. Where necessary, staff undertake research prior to these meetings for example, an element of the meeting of 15.11.05 referred to aspects/quality of care. Staff had conducted research into the benchmark for quality care as detailed in guidance from the Department of Health’s ‘Essence of Care’. A visitors comment received stated about the home “ for the past three years I have always been treated with warmth and courtesy”. Rylands DS0000064650.V256333.R01.S.doc Version 5.0 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 3 x 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 x 10 4 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 3 x 3 3 3 3 3 STAFFING Standard No Score 27 3 28 x 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 4 4 x x 3 4 3 Rylands DS0000064650.V256333.R01.S.doc Version 5.0 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 OP19 Regulation 23(2)(l) Requirement Provide storage for the purposes of the home. (The owners have given an undertaking to include this in further improvements to the home) To upgrade the sluicing facility on the first floor. (The owners have given an undertaking to progress this as part of the improvement plan for the home) Timescale for action 31/01/07 2 OP26 23(2)(k) 29/04/06 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 Rylands DS0000064650.V256333.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Shrewsbury Local Office 1st Floor, Chapter House South Abbey Lawn Abbey Foregate SHREWSBURY SY2 5DE 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 Rylands DS0000064650.V256333.R01.S.doc Version 5.0 Page 22 - 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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