Inspection on 01/08/06 for Ryton Towers

This inspection was carried out on 1st August 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Ryton Towers 06/08/07

Ryton Towers 22/09/05

Ryton Towers 07/06/05

Ryton Towers 11/01/05

Ryton Towers 23/07/04

Ryton Towers 04/03/04

Similar services:

The Highlands

Turret Villa Retirement Home

Moor House

Blenheim House

1 Lanark Close

Mendip House

Beaconsfield Court Care Home

Ann Charlton Lodge

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

CARE HOMES FOR OLDER PEOPLE Ryton Towers Whitewell Lane Ryton Tyne & Wear NE40 3PG Lead Inspector Miss Nic Shaw Key Unannounced Inspection 9:30 1 & 9th August 2006 st 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 Ryton Towers DS0000007432.V294394.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Ryton Towers DS0000007432.V294394.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Ryton Towers Address Whitewell Lane Ryton Tyne & Wear NE40 3PG 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) 0191 413 8518 0191 413 8518 Wellburn Care Homes Limited Care Home 43 Category(ies) of Dementia - over 65 years of age (10), Old age, registration, with number not falling within any other category (43), of places Physical disability over 65 years of age (6), Sensory Impairment over 65 years of age (2) Ryton Towers DS0000007432.V294394.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 22nd September 2005 Brief Description of the Service: Ryton Towers is a large adapted two storey building. It is registered to provide personal care for 43 people who are older, ten of whom may have a dementia type illness, six of whom may have a physical disability, and two of whom may have a sensory impairment. A short break service is also offered at Ryton Towers. The service cannot provide nursing care, however, district nursing services can be accessed as required. The building consists of 37 single bedrooms, 27 of which have en-suite WC facilities, and 3 double rooms. There are two spacious lounges and separate dining facilities and an accessible emergency call system is provided in all individual bedrooms, bathrooms and communal areas. Ryton Towers is set in its own grounds with adequate car parking facilities to the front and side of the building. The home has wide passageways and is accessible for people who use wheelchairs. A passenger lift enables the residents to access the first floor as well as an attractive stairwell, which is a positive feature of the home. The home is located in the heart of Ryton village within close proximity to a variety of village features such as shops, places of worship, the local park, tennis court and bowling green. There are also bus stops nearby which link with the main regional centres. Ryton Towers DS0000007432.V294394.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out over two days in August 2006 and was a scheduled unannounced key inspection. The inspection included information which had been provided by the manager in a pre-inspection questionnaire. Time was spent talking with the manager and deputy manager, a number of the residents and their visiting relatives, and some of the staff. A meal was taken with the residents on the first day of the inspection. A tour of the building including all communal areas and a selection of bedrooms also took place. Four residents with very different needs were selected to “casetrack”. This process involved talking with those residents and where possible their relatives, observing staff interactions with them and checking that information obtained from discussion and observation was accurately recorded in the care records. The manager said that people who live in Ryton Towers prefer to be referred to as residents and this will be reflected throughout this report. The fees range from £356-£395 per week. What the service does well: The manager makes sure that the home is suitable for any resident placed there by carrying out her own assessment of their needs as well as making sure that she obtains up-to-date information from the social worker. Relatives said that the staff made sure that their family members health care needs are met and that the staff always kept them informed if there were any changes in their relative’s health. There is good contact maintained with family and friends and relatives said they could visit anytime, even early in the morning. They also said they would have no hesitation in making a complaint as the staff, manager and deputy manager were very approachable. Mealtimes are a relaxed social occasion and everyone said that the food was good with plenty of choices. A cooked breakfast is available each morning and dining tables are immaculately presented “hotel” style with linen clothes and napkins. There is plenty for people to do in the home and there are regular trips out for the residents. Activities are a real strength of the home with a varied programme, which is provided to each resident in an information pack in their Ryton Towers DS0000007432.V294394.R01.S.doc Version 5.1 Page 6 bedrooms. Lay people from the local church and a priest visit the home so that residents can follow their chosen religious beliefs. The building, which has the appearance of a large country home set in its own grounds, has benefited from extensive refurbishment. It is immaculately clean and well maintained and everyone benefits from being able to access the spacious garden area which is enhanced with a range of colourful plants. The environment offers everyone, particularly those people with dementia, a therapeutic, calm place to live. There is little turnover in staff. This means that staff have time to get to know the needs of the residents and therefore are able to provide continuity of care. Staff training is very good and as well as being paid to attend every training course arranged for them the manager regularly provides in-house training on topics such as the home’s policies and procedures and abuse awareness. Residents said : “there is lots to do” “the food’s nice” “the staff are lovely” Relatives said: “I know my mam is safe here” “all of the staff are friendly” “I am made to feel welcome and can visit at any time” “the staff are lovely” Staff said: “We feel we can approach the manager” “there is always extra staff brought in to cover for appointments and outings” “we feel we can express our views at handovers” “we are encouraged to put forward suggestions” “it’s a nice place to work”. What has improved since the last inspection? A number of areas of the home have been re-decorated and new curtains and blinds have been purchased for the dining room, resident’s bedrooms and conservatory area of the home. Some of the medication procedures have improved. For example: there is now an accurate record kept of the controlled drugs held in the home. Wardrobes have been attached to walls, so that they do not topple over, and the loose wiring found during the last inspection has been addressed. Some of the staff have completed training in dementia care so that they are better able to meet some of the resident’s needs. Ryton Towers DS0000007432.V294394.R01.S.doc Version 5.1 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Ryton Towers DS0000007432.V294394.R01.S.doc Version 5.1 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Ryton Towers DS0000007432.V294394.R01.S.doc Version 5.1 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. The admissions process ensures that resident’s are adequately assessed prior to care being offered. This helps to ensure that residents are offered the right type of care at the home. The home does not provide intermediate care. EVIDENCE: Of the sample of resident’s case files chosen to casetrack a social work care plan had been obtained prior to the resident’s admission to the home. Although not the social work assessment, the information contained within the care plan document was of sufficient detail to enable the manager to make a decision as to whether or not Ryton Towers would be able to meet the prospective residents care needs. Discussion with the manager and visiting relatives confirmed that prospective residents are always invited to visit the Ryton Towers DS0000007432.V294394.R01.S.doc Version 5.1 Page 10 home in order to help them to decide if it is the right place for them. It is during this visit that the home completes its own assessment documents. The manager confirmed that, although not a regular occurrence, they may from time to time admit a person in an emergency situation. The home also offers a short break service to some people. It was advised that the development of policies and procedures in relation to these situations would provide staff with clear guidance on what to do to ensure that the home is able to meet the needs of people admitted in these ways. For those people who regularly stay in the home for a short break, this should include obtaining up to date information on the person’s care needs prior to each stay. Ryton Towers DS0000007432.V294394.R01.S.doc Version 5.1 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 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. The residents health and social care needs are currently not fully reflected in the care plans and therefore guidance is not always available to ensure that the staff provide continuity of care. Medication is generally administered following recognised good practice, however, recording and auditing arrangements need to improve to show that the residents have been given the medication which they have been prescribed. Staff undertake appropriate care practices that help to preserve the residents privacy and dignity. EVIDENCE: Care plans were examined for those people chosen to casetrack. The layout of the care plan is clear and easy for staff to follow with the area of need identified at the top of the page followed by the actions required to meet the assessed need. However, care plans had been developed for all aspects of Ryton Towers DS0000007432.V294394.R01.S.doc Version 5.1 Page 12 personal care when this has not been identified as an assessed need. For example: all residents have a care plan in place for the routine administration of prescribed medication. The manager agreed this is not necessary and is in the process of reviewing all care plans. It was good to note that care plans had in some instances been developed to guide staff on interventions needed of them to meet the needs of those people with dementia. However, some of the resident’s behaviour identified in the daily record, for example; a resident being described as “disruptive” during the night, was not reflected in the care plan. In addition to this although there was evidence that the “identified need “section of the care plans had recently been up-dated to reflect the residents changing personal care needs, for example; “now needs 2 staff” the staff intervention section had not similarly been up-dated. The care staff carry out a monthly evaluation of the care plan and records are maintained of this. The manager also arranges a six monthly review meeting with the residents and their relatives. The manager has recently been provided with a nutritional assessment tool which she is to complete for all residents. However, this document asks for the “BMI” of the resident and information in relation to “stress factors” such as “minor infection” and “chronic disease”. Staff have not been given training or guidance in relation to what this means and therefore may find it difficult to accurately interpret and use the information. The residents weight is monitored each month, however, as a result of how this information is recorded it was not easy to establish if a resident had lost or gained weight. Following advice during the inspection the manager has changed the recording system to address this issue. Relatives spoken to said that their family members health care needs were met in the home and that the staff always kept them informed of any changes in this area. A record of GP, district nurse, chiropody and optical appointments is maintained in the resident’s case file. On the day of the inspection an optician was visiting a number of the residents. Specialist pressure relieving equipment has been provided for those residents that require this, however, care plans did not always reflect the positive interventions of the staff particularly in relation to the preventative action they take to address the special needs of those residents at risk of developing a pressure sore. Currently none of the residents look after their own medication, however, lockable facilities are provided in the residents bedrooms for the safe storage of medication should such a situation arise. Recently the manager has arranged with the supplying pharmacist to change the monitored dosage system used in the home from a 4 weekly “blister pack” to a weekly “Nomad” cassette. An examination of the medication records for those people chosen to Ryton Towers DS0000007432.V294394.R01.S.doc Version 5.1 Page 13 casetrack indicated that staff would benefit from training on the use of this system, particularly how to use the medication administration record (MAR). For example: when attempting to carry out an audit trail this was made difficult as staff had not recorded the most recent medication count in the correct box on the MAR sheet. The manager agreed that this was a training need and has since informed the Commission that this issue has been addressed. One resident had been prescribed a medication, one or two tablets as required, however, it was not clear from the MAR sheet whether one or two had been given. Another resident had been prescribed an “as and when required” medication to be administered when they become distressed. There was no plan in place to inform staff of when it is appropriate to give this medication or to advise them of what other strategies they should carry out prior to resorting to the use of this medication. Senior staff are responsible for the administration of medication and they have all completed training in the safe handling of medicines. A small number of controlled medication is held in the home in a separate controlled drugs cabinet. A controlled drugs register is maintained and a brief audit of the medication held in stock corresponded to the records. There is a separate medication fridge and records are maintained of the temperature of this to ensure that medication is stored appropriately. Following advise given during the inspection the manager has informed the Commission that she has purchased a medication counting device, so that she can accurately count the medication held in the home, and a thermometer for the medication room, so that the temperature in this area can be monitored. Discussion with the deputy confirmed that medical appointments are always conducted in the privacy of the resident’s bedroom. There is a telephone in the hallway which can be plugged into people’s bedrooms so they can make calls in private. Some of the residents have their own telephones. Privacy screens are provided for use in double rooms, although none of the rooms are currently used in this way. Ryton Towers DS0000007432.V294394.R01.S.doc Version 5.1 Page 14 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 Quality in this outcome area is excellent. This judgement has been made from evidence gathered both during and before the visit to this service. Arrangements to provide activities and stimulation are of an excellent standard and cover the diverse needs of the residents living at Ryton Towers. This means that residents are provided with many opportunities to lead fulfilling lifestyles. Residents are able to maintain contact with their family and friends and contact with the local community is very good. This ensures that residents do not become socially isolated. Residents are actively encouraged by staff to a good degree in exercising choice and control over their lives which enables them to remain independent. Residents receive a good, varied and well presented choice based menu which meets their diverse likes and tastes. This ensures that the residents general health and well being is promoted. EVIDENCE: There is an activities co-ordinator in post who was on duty on the day of the inspection. An activities programme is available to each resident in their bedrooms as well as a bright colourful board advertising forthcoming activities Ryton Towers DS0000007432.V294394.R01.S.doc Version 5.1 Page 15 and outings located in the entrance foyer. Residents and relatives without exception commented on the wide range of activities available saying “there is always something going on”. Regular activities include baking sessions, reminiscence, arts and crafts, flower arranging and pamper days. One relative spoken to said that the staff had recently taken their family member to the local pub for a Shandy. During the inspection an outing was taking place for some of the residents to a local place of interest whilst others were engaged in a “keep fit” session. In addition to the daily activities it is a minimum standard of the company to ensure that at least two group outings are arranged and two entertainers brought into the home each month. The manager said that the home’s line manager, as part of the quality assurance process, monitors this. In order to meet the diverse religious needs of the residents a priest visits the home each Friday and lay members of a local church also visit to chat with those residents who follow the Catholic faith. A Church service is also held in the home each month and the manager said that some relatives accompany their relatives to church. Each Easter, members of the local church parade through Ryton village, carrying a cross, and complete their journey with a service held in Ryton Towers. This not only provides evidence of how the residents religious needs are met but also how the home is regarded as a central feature of the local community. Local community groups also have regular contact with the home and these include a group of older citizens who provide entertainment. A local historian has also recently visited the home to present a slide show of Ryton Village in years gone by. Relatives said they could visit anytime and were always made to feel welcome. One relative said that this a real positive aspect of this home as she liked to visit her family member early each morning. One resident’s sister visits the home each day, working as a volunteer, serving tea and biscuits to the residents throughout the day. Residents and relatives spoken to said that the food was good. They said that they are able to have a cooked breakfast and a choice of main meal and pudding is always offered. The dining tables were immaculately presented with linen tableclothes, napkins and condiments so that residents can help thesmselves. A lunchtime meal was shared with three residents. Staff were observed to be courteous, encouraging the residents independence throughout. A choice of cranburry or orange juice was offered followed by tea or coffee. Relatives said that during the recent hot weather plenty of drinks were offered both to them and the residents. The menu is regularly reviewed, in consultation with the residents. The manager has recently been sent a list of a wide range of different meals by the Ryton Towers DS0000007432.V294394.R01.S.doc Version 5.1 Page 16 company to help her with this process. One resident buys their own food. The cost of this is reimbursed by the home. It was clear that residents are able to continue their own preferred daily routines and to make their own choices about how they spend their day. Some residents chose to spend time in their bedrooms whilst others preferred to spend time sitting in the entrance foyer watching the busy comings and goings of the home. Information leaflets are available to residents on local advocacy groups as well as information on enduring power of attorney to help them make decisions about their lives. Ryton Towers DS0000007432.V294394.R01.S.doc Version 5.1 Page 17 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 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. The home has a satisfactory complaints system. Complaints are handled appropriately and the outcomes used to improve the service. However, the complaints procedure is not available in a format suitable for those people who have a visual impairment. This may prevent some of the residents from expressing their views. Policies and procedures are in place in relation to adult protection, however staff need to receive further training in relation to this issue to fully protect the residents from abuse and potential harm. EVIDENCE: The home has a complaints procedure which is available to the residents and their relatives in the “Service User Guide” which is displayed in each bedroom. Residents and relatives spoken to, without exception, said that they would have no hesitation in approaching the manager or staff if they had any concerns or complaints. However, in order to meet the requirement of regulation 22(6) the complaints procedure needs to be made available in a suitable format for those people who have a visual impairment. The telephone number for the Commission also needs to be added to this. Ryton Towers DS0000007432.V294394.R01.S.doc Version 5.1 Page 18 The complaints record examined showed that there has been one recent complaint. This had been thoroughly investigated by the home’s line manager with the outcome and action taken clearly documented. Discussion with staff confirmed that they were knowledgeable of the different types of abuse and said that they would have no hesitation in reporting a colleague if they witnessed or suspected that this had occurred. All of the staff have recently been shown a film entitled “What do you see” in order to alert them on the different types of abuse. However, in order to further raise staff awareness of this issue they need to receive training on the Local Authority’s adult protection policy and procedure. Discussion with the manager and the training plan confirmed that this issue is soon to be addressed. Following advice given during the inspection the manager has obtained a copy of Gateshead Local Authority’s adult protection procedure. Ryton Towers DS0000007432.V294394.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19&26 Quality in this outcome area is excellent. This judgement has been made from evidence gathered both during and before the visit to this service. Ryton Towers offers residents a clean, homely, well maintained place to live with fixtures and fittings throughout of an excellent standard. EVIDENCE: The building throughout was found to be immaculately clean with no unpleasant odours. There are two communal lounges located on the ground floor, fully accessible to all residents. These areas are bright, airy comfortable places in which to sit and chat with friends and relatives offering plenty of space for the residents to engage in the many activities on offer in the home. Carpets and other flooring were clean and decoration throughout is of a high standard. There are two conservatory areas, one of which leads from a lounge into the garden which everyone can freely access. The smaller conservatory area is soon to be refurbished as part of the home’s on-going maintenance plan. Ryton Towers DS0000007432.V294394.R01.S.doc Version 5.1 Page 20 A particular striking feature of the home is the wide “sweeping” staircase in the entrance foyer. Many residents were observed to choose to sit in this area and recently new leather easy chairs have been provided for the comfort of the residents and add to the “stately” feel of the home. The spacious grounds are immaculate with beautiful well maintained hanging baskets and potted plans. There is an outside terrace with tables/chairs and umbrellas which the residents said they have been making good use of during the recent hot weather. People with dementia are not accommodated in a separate “unit” or “wing” of the home, sharing the same communal facilities as those people who do not have dementia. This works really well in this home with a quiet therapeutic relaxed environment being provided. Toilets and bathrooms are clearly labelled so that people with dementia can find their way. Those bedrooms viewed were found to be clean and well personalised reflecting each individuals likes and tastes and the manager confirmed that residents are offered a key to their room on admission. On the day of the inspection all of the locks on doors throughout the building were being upgraded. There are three rooms, which can be used as doubles, but at the moment all rooms are used as singles. The commitment to providing the residents with a well maintained environment was evident during the two inspection visits. A handyman is based in the home and at the time of the inspection was decorating a bedroom. Other recent improvements to the home include the corridor being re-decorated, carpets throughout being replaced and blinds purchased for a number of resident’s bedrooms and the conservatory area. There was also a person attending to the plants in the garden. Staff are provided with training in relation to infection control as part of their induction. Throughout the inspection staff demonstrated an awareness of good care practise in relation to this issue with the appropriate use of protective gloves and aprons. There is a separate laundry facility which was found to be well organised. Washing machines have a sluice facility so that any soiled clothing can be washed appropriately. Ryton Towers DS0000007432.V294394.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29&30 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Staffing levels are good which ensures that the resident’s needs are effectively met. In order to ensure that the residents welfare is protected improvements must be made to the staff recruitment procedures. The way training is planned ensures that the staff gain a greater understanding of the residents needs, however, further training is needed in the area of dementia to ensure that the needs of people with short term memory loss are effectively met and in equality and diversity so that staff are able to meet the diverse needs of present and prospective residents. EVIDENCE: Relatives and residents said that they liked the staff. During the inspection visits the staff appeared relaxed and confident in the tasks they were undertaking. Some of the staff have worked in the home for a number of years, providing the residents with continuity of care. There has also been very little turn over in staff. Discussion with staff confirmed that they are provided with lots of training all of which is paid for by the company. In addition to NVQ level 2 and 3 training in care, which 61 of the staff have achieved, some of the staff have Ryton Towers DS0000007432.V294394.R01.S.doc Version 5.1 Page 22 completed in-depth training on medication and dementia care. As the home is registered to provide a service to 10 people who have dementia the manager was advised that all of the staff must be provided with specialist training in this area. Discussion with the deputy manager, who has completed this training, said that she found it to be very beneficial and has made her much more aware of the needs of people with this illness. None of the staff have received training in relation to equality and diversity and this is necessary so that they know how to meet the diverse needs of current and prospective residents. There is a training matrix in which details of each staff members training is recorded. This enables the manager to plan training to ensure that the staff are provided with the knowledge they need to carry out their job role effectively. As well as external training courses, on-going in house training is provided by management. This includes discussing a selection of the home’s policies and procedures as well as role play as a way of raising staff awareness of those everyday difficulties older people with disabilities may encounter, such as what it fees like to be “fed” a meal or “pushed” in a wheelchair. Records are maintained of this additional training. The staffing levels of 6 staff each morning and evening with 5 nightstaff are suitable to meeting the needs of the current residents. Staff also said that they felt that there was plenty of them on duty each shift. They also said that additional staff are brought in to cover for hospital appointments and help out when outings have been arranged. Copies of the General Social Care council code of practise were on display in the home for staff to freely access. Of the staff files examined, although evidence was available that a “POVA” first and Enhanced Criminal Records Bureau check had been obtained prior to prospective employees working in the home, a reference form the last person’s employer had not always been sought. In addition to this references had not always been obtained from the employees previous manager, and the job application form had not been fully completed to show if there had been any gaps in their employment history, which should be explored with them at interview. Ryton Towers DS0000007432.V294394.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35&38 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. The residents health, safety and welfare is promoted by a well managed home and robust procedures are in place to safeguard the residents finances. Internal quality assurance systems and quality management of the service have been developed to a good level, which allows for the residents, relatives and others views to be sought and used to improve the service. However, there is no annual development plan for the home and therefore residents and their relatives do not know if the home has achieved its aims and objectives. EVIDENCE: The current manager, who has been in post since January 2006, has worked for the company for eleven years. She has substantial management experience both as a manager and deputy manager and describes her Ryton Towers DS0000007432.V294394.R01.S.doc Version 5.1 Page 24 management style as “fair” and “open”. Staff confirmed that the manager would “keep a confidence” and both residents and staff said that they felt her to be approachable. Relatives said that when the manager started working in the home she took time to introduce herself to them, which they thought was good. She has achieved the NVQ level 4 qualification in Management, the Registered Managers Award and the D32 and D33 NVQ assessor qualifications. She has also undertaken periodic training to ensure that her knowledge is kept up-to-date. However this training has not included equality and diversity and this is recommended so that she has a better understanding of how to ensure the diverse needs of residents are fully met. The personal allowance records for two of the residents were examined and demonstrated that receipts and double signatures are maintained for all transactions. A weekly audit of the personal allowance record is carried out by the manager and records maintained of this. There was no annual development plan available for Ryton Towers, however, there is a detailed quality assurance policy and procedure in place. This involves residents meetings, customer satisfaction questionnaires sent to residents and relatives and regular checks of the environment, and other processes such as medication and the resident’s personal allowance record. Staff records confirmed that training in relation to health and safety matters is on-going. An appropriate record of accidents is maintained which includes any action taken following the accident. A member of staff has been delegated the responsibility of ensuring fire alarms are tested weekly and that fire fighting equipment is checked monthly. In addition to this it is their responsibility to ensure that all staff regularly receive fire instruction and drill. Records confirmed that this is carried out effectively and includes detailed questionnaires in fire safety for staff to complete. Radiators have been fitted with radiator guards, however, the design of these is such that a resident, if they have a fall, could get a hand caught through the bars and may be at risk of burning. This issue has been raised with the proprietor during inspections of other services, which have similar radiator guard designs, who has stated that environmental health officers are satisfied with them. The proprietor has agreed to forward a copy of the report to the Commission confirming this. In the meantime the manager was advised to carry out her own risk assessment in relation to these. Ryton Towers DS0000007432.V294394.R01.S.doc Version 5.1 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 X X 3 X 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 4 13 4 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 4 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 2 Ryton Towers DS0000007432.V294394.R01.S.doc Version 5.1 Page 26 Are there any outstanding requirements from the last inspection? 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 15 Requirement Resident care plans must be in sufficient detail to guide staff on the action they must take to meet the residents care needs. (Timescale not met 01/01/06). Resident care plans must be in sufficient detail to guide staff on the action they must take to meet the residents care needs. (Timescale not met 01/01/06). The manager must ensure that records accurately reflect quantity of medication administered to the residents. Clear guidance must be available to instruct staff of when to administer “as and when required” medication. The complaints procedure must be made available in a format suitable to those people who have a visual disability. The manager must ensure that all staff complete training in the Local Authority’s adult protection policy and procedure. Staff recruitment procedures DS0000007432.V294394.R01.S.doc Timescale for action 30/11/06 2. OP7 15 30/11/06 3. OP9 13 30/09/06 4. OP16 22(2) 30/09/06 5. OP18 13 30/11/06 6. OP29 19 30/08/06 Version 5.1 Page 27 Ryton Towers 7. OP30 18(2) 8. 9. OP33 OP38 24(b) 13(4)( c ) must be improved to ensure the protection of residents. Staff must receive in-depth training in dementia and equality and diversity so that they can effectively meet the needs of the residents. The quality assurance system must include an annual development plan for the home. A risk assessment must be carried out for the type of guards fitted to radiators. 31/12/06 21/12/06 30/08/06 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 OP33 Good Practice Recommendations A policy in relation to equality and diversity should be developed. Ryton Towers DS0000007432.V294394.R01.S.doc Version 5.1 Page 28 Commission for Social Care Inspection South of Tyne Area Office Baltic House Port of Tyne Tyne Dock South Shields NE34 9PT 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 Ryton Towers DS0000007432.V294394.R01.S.doc Version 5.1 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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