Inspection on 06/08/07 for Ryton Towers

This inspection was carried out on 6th August 2007.

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

Ryton Towers 01/08/06

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 Unannounced Inspection 9:30 6 &7 August 2007 th 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 Ryton Towers DS0000007432.V336232.R02.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. Ryton Towers DS0000007432.V336232.R02.S.doc Version 5.2 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 7234 Wellburn Care Homes Limited Lynn Ree 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.V336232.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 1st August 2006 Brief Description of the Service: Ryton Towers is a large adapted two storey building. It is registered to provide personal care for 41 people who are older, ten of whom may have a dementia type illness. The service cannot provide nursing care, however, district nursing services can be accessed as required. The building consists of 38 single bedrooms and two double rooms. There are two spacious lounges and separate dining facilities and an emergency call system is provided in all individual bedrooms, bathrooms and communal areas. Ryton Towers is set in its own grounds with good car parking facilities to the front and side of the building. The home has wide passageways and is suitable 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. The weekly fees range from £350-£535. Ryton Towers DS0000007432.V336232.R02.S.doc Version 5.2 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 2007 and was a key unannounced inspection. The inspection included information which had been provided by the manager in the Annual Quality Assurance Assessment. Three completed relatives/visitors questionnaires were also received as part of the inspection process. Time was spent talking to the manager, residents, staff and visitors. Some time was spent touring the building, including a number of residents bedrooms, lounges, dining area and bathrooms. A sample of staff records were also looked at. The inspection particularly focussed on four residents with very different needs, known as “casetracking”, and looked at what it was like, from their point of view, living at Ryton Towers. This involved talking with those residents, observing staff’s care practices with them and checking that information obtained from discussion and observation was accurately recorded in the care records. What the service does well: The manager makes sure that Ryton Towers is able to meet the needs of prospective residents by getting a copy of their social work assessment and also completing her own assessment before they move in. The staff make sure that residents are treated with dignity and respect. The activities available are excellent and everyday there is something for residents to do. There is good contact maintained with family and friends and relatives are able to visit anytime. Mealtimes are a very pleasant occasion in Ryton Towes. Dining tables are beautifully presented and there is always a choice of main meal and pudding. Everyone said that if they had any concerns or complaints they would have no hesitation in talking to the manager or staff about them. 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 use 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. Ryton Towers DS0000007432.V336232.R02.S.doc Version 5.2 Page 6 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 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 The home is well managed, and there are frequent checks by the manager and area manager to make sure the good standard is kept up. Residents and relatives are asked for comments and suggestions about the service they receive. Their comments are used to continually make improvements to the service. What has improved since the last inspection? What they could do better: Care plans need more information in them and be kept up-to-date so that staff can make sure the residents health and personal care needs are fully met. Medication needs looking at as sometimes residents have not been given their prescribed medication. Other improvements also need to made to the medication procedures, such as photographs of the residents, to help prevent staff from making mistakes when giving out medicines. Residents should be able to decide when they have a bath. It is not good practise to allocate residents with a “bath day”. Ryton Towers DS0000007432.V336232.R02.S.doc Version 5.2 Page 7 Although staffing levels are good, when the manager has been on holiday and people have phoned in sick, replacement staff have not always been found. This needs looking at. The manager must make sure that people from overseas are allowed to work in this country. All staff should have training in dementia care so that they are better equipped to meet the residents needs. The number of accidents has increased in the last 2 months and the manager needs to try and find out why this. The bathwater temperatures need to be kept at as near to 43 degrees centigrade as possible and all radiators that have a hot surface need to be guarded so that residents are not in danger of being scalded. There should be an annual development plan for the home so that residents know where improvements have been made. The manager needs to make sure that some of the handwritten receipts given to residents are in enough detail to fully protect them from financial abuse. 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. Ryton Towers DS0000007432.V336232.R02.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Ryton Towers DS0000007432.V336232.R02.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3&6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The admissions process ensures that residents are adequately assessed prior to care being offered. This means that residents know that their needs will be met at Ryton Towers. EVIDENCE: Admissions are not made to the home until a full needs assessment has been undertaken. For people who are self funding and without a care management assessment, the manager always visits the prospective resident in order to complete her own assessment documentation. The assessment involves the Ryton Towers DS0000007432.V336232.R02.S.doc Version 5.2 Page 10 individual and their family or representative. Prospective residents are always invited to spend the day at the home so that they can “test” the service. Ryton Towers DS0000007432.V336232.R02.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. 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 using available evidence including a visit to this service. Although there have been some improvements to the care planning process the resident’s health and social care needs are not fully reflected in the care plans and therefore guidance is not available to ensure that the staff provide continuity of care. Medication administration procedures do not protect the residents. Staff care practices preserve the residents’ dignity and privacy. EVIDENCE: Care plans no longer cover all aspects of personal care, regardless of whether or not this has been assessed as a need and they focus much more upon the individual and their strengths. However, the quality of information in the care plans varied. For example, although the format of the plan begins by focusing Ryton Towers DS0000007432.V336232.R02.S.doc Version 5.2 Page 12 upon the resident’s strengths, in some instances staff were not clear what to record here and instead had recorded the person’s disability. Some of the plans lacked detail and did not provide step by step information to guide staff. For example, a care plan written in relation to “appetite” did not identify how food and fluid intake were to be monitored, how often the resident should be weighed and who should be responsible for this. For one resident, who due to their dementia, it had been identified that they become restless at night, there was no plan in place to inform staff of how best to meet this person’s needs in such a situation. Falls risk assessments are completed and in one resident’s care plan it had been identified that they were at low risk of falling. In practise this was clearly not the case and staff said that this person was always falling, if staff were not around to supervise them. It was positive to note that attention was paid to the dignity of the residents and in one plan the importance of wearing lipstick to one person had been recorded, however, again the detail of the support this resident requires in relation to this was missing. Two nutritional assessment tools are completed for all residents. One of these assessments requires care staff to identify whether residents are “stuperous” and whether or not they have a “swallowing reflex”. Given the fact that care staff are not trained nurses they may have difficulty accurately interpreting and using the information. In one residents file the two differing assessment tools, when completed, gave conflicting information. 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 residents weight is monitored each month. Food and fluid charts are used to monitor nutritional intake where this has been identified as a need. However, in one instance this was not being monitored for one resident where this has been identified as a need. Residents said that they felt their health care needs were met in the home and relatives said 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. None of the current residents have a pressure sore. 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. Medication is dispensed by the pharmacist in a “Nomad” cassette each week. Staff do not see the original prescriptions, rather the pharmacist collects these on behalf of the home, and Ryton Towers DS0000007432.V336232.R02.S.doc Version 5.2 Page 13 therefore staff cannot be assured that the medication they are administering has been prescribed by the GP. There are no photographs of residents on the medication administration record. The code “o” had been used on a number of occasions on the medication administration record to show that loose medication such as paracetamol had been “omitted” for a number of days for some of the residents. The manager said that this was due to the home having “run out” of the medication and clearly indicated a fault with the home’s medication ordering procedure. Senior staff confirmed that the manager had identified this as an area of concern and she has reviewed the medication administration procedure so that this does not happen again. A resident who had recently been admitted to the home had gone without their prescribed medication for three days. The manager said that this was due to their being a problem with swapping GP’s. A record is not maintained of prescribed creams which are administered by staff. Staff do not always watch to make sure that residents have taken the medication they have given to them. 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. However the temperature of the medication room is not monitored to make sure that medication is stored appropriately. 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. Residents said that the staff always treated them with dignity and respect and were very good at making them feel at ease when assisting them with their personal care. Ryton Towers DS0000007432.V336232.R02.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,&15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements to provide activities, stimulation and community contact are excellent with lots of opportunities being provided for residents to maintain contact with their family and friends. This ensures that residents lead fulfilling lifestyles. Residents ability to fully exercise choice and control over their lives is sometimes limited by the daily routines of the home. Residents are provided with a good, varied and well presented, choice based, menu which helps to promote their general health and wellbeing. EVIDENCE: There is an excellent activities programme available to each resident in their bedrooms, as well as a bright colourful board advertising forthcoming activities and outings located in the entrance foyer. There is a full time activities coordinator and they maintain a detailed record of the activities which have Ryton Towers DS0000007432.V336232.R02.S.doc Version 5.2 Page 15 taken place and who has joined in. Regular activities include arts and crafts, exercise sessions, bingo, flower arranging, carpet bowls, yoga, and aromatherapy. There are also regular days trips to local places of interest and the Metro Centre. Some of the residents spoke enthusiastically of a recent trip to Amble. A hairdresser visits the home every week. On the morning of the inspection some of the residents were sitting in the conservatory reading the daily newspaper or a book. Residents commented that when there are enough staff there is plenty to do. Relatives said “the carers spend time to get to know the residents, to enable to support them in the activities they enjoy”. There is a beautiful safe garden which residents can independently use when the weather is nice. In order to meet the different 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. 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. However, everyone said that they were allocated a day during the week when they were able to have a bath and although they could choose if they wanted a bath in the morning or afternoon this practise is institutional and does not promote person centred care. The menu was not displayed on the board on the day of the inspection and residents said that they did not know what was for lunch. 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. Generally residents said that the food was very good. A cooked breakfast is always provided 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 could help thesmselves. A lunchtime meal was shared with three residents. Staff were observed to be courteous, encouraging the residents independence throughout. A choice of juice or water was offered followed by tea or coffee. The menu is regularly reviewed, in consultation with the residents. As a result of this home made soup is now provided each eveining. Ryton Towers DS0000007432.V336232.R02.S.doc Version 5.2 Page 16 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. This judgement has been made using available evidence including a visit to this service. The home has a satisfactory complaints system. Complaints are handled appropriately and the outcomes used to improve the service. Policies, procedures and staff training ensure that the residents are protected from abuse and potential harm. EVIDENCE: The home has a complaints procedure, a copy of which is available to each resident in their bedroom, in the information pack. Residents and relatives said that they would have no hesitation in approaching the manager or staff if they had any concerns or complaints. There has been one complaint made to the manager since the last inspection. This had been fully investigated and the outcome and action taken as a result clearly documented. The home has its own policy and procedure documents relating to this which are available to staff to guide them if they have any concerns in this area. The Ryton Towers DS0000007432.V336232.R02.S.doc Version 5.2 Page 17 manager has also obtained a copy of Gateshead Local Authority’s safeguarding adult procedure. All staff working in the home are trained in safeguarding adults. There have been no safeguarding adult referrals made since the last inspection. This is as a result of lack of incidents rather than a lack of understanding about what incidents should be reported. Ryton Towers DS0000007432.V336232.R02.S.doc Version 5.2 Page 18 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 excellent. This judgement has been made using available evidence including a 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 was found to be immaculately clean and fresh smelling throughout. There are two communal lounges located on the ground floor. 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 Ryton Towers DS0000007432.V336232.R02.S.doc Version 5.2 Page 19 use. Some of the windows in this area need to be replaced and as there are no ceiling blinds, this area was very warm on this sunny August day. The manager confirmed that this area is to be re-furbished in October 2007 as part of the on-going maintenance programme. 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 in the leather easy chairs provided watching the comings and goings 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. 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. However, some of the patterned carpets may cause difficulty for some people with dementia, who have needs in relation to perception and vision, and consideration needs to be given to this as the re-furbishment programme progresses. Those bedrooms viewed were found to be clean and well personalised, reflecting each individuals likes and tastes. Some residents like to look after their own rooms, make their own beds and attend to their own wardrobes. This is encouraged and supported by staff. Residents said that they did not have a key to their room but did not feel that they needed one. They said that if they wanted one they would ask the manager. There are two bedrooms, which can be used as doubles, but at the moment all rooms are used as singles. Staff are provided with training in relation to infection control as part of their induction and all staff are soon to attend a distance learning course in this subject. 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.V336232.R02.S.doc Version 5.2 Page 20 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. This judgement has been made using available evidence including a visit to this service. Staffing levels are good and staff training is excellent, however, in order to ensure the resident’s needs are effectively met all staff should be provided with more in-depth training in dementia care. In order to ensure that the residents welfare is protected some improvements must be made to the staff recruitment procedures. EVIDENCE: It was evident during the inspection that the staff support one another and work well as a team. They were confident in their work and eager to take part in the inspection process. Residents spoke positively about the staff and it was clear that positive respectful relationships had developed between staff, the residents and their relatives. There has been a low turnover of staff, which is excellent in terms of promoting continuity of care. Staffing levels are maintained at 6 staff during the day with 5 staff during the evening and 3 night staff. The manager also makes sure that staffing levels are increased when social events are taking place, for example, the summer barbeque. However, staff said that sometimes Ryton Towers DS0000007432.V336232.R02.S.doc Version 5.2 Page 21 due to sickness and holidays they have been stretched and although cover is normally arranged to cater for this, when the manager was on holiday in June 2007 this had not always taken place. The manager completes a training audit that shows training completed and training that is required for all staff. Certificates for all training completed by staff are kept in their personal file. Apart from two, all of the staff have completed or are in the process of completing the NVQ level 2 training in care. Some of the staff have also completed the NVQ level 3 qualification. Other training completed by staff includes equality and diversity and the senior staff have completed a twelve week course in dementia care. All other staff have completed an awareness course in dementia and four staff are scheduled to undergo accredited dementia training, however, given the home is registered to accommodate 10 people with dementia, all care staff must be provided with this training. Staff who had completed training in dementia commented that it had really made them think about why some of the residents behave in the way that they do. For example, staff talked about one resident who did not want to step from one room to another. After the training they were able to identify that this was because the carpets in the two rooms contrasted in colour, which for some people with dementia causes them difficulties. There is an induction programme in place for all new staff. As part of the induction process new staff shadow an experienced member of staff and are additional to the minimum staffing levels. An excellent aspect of the training is the on-going in house training 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 encounter. Staff files examined were easy to follow and well organised. All contained application forms, an interview record and references. Two references are always sought, one from the last employer. Criminal Record Bureau clearance and Protection of Vulnerable Adults (POVA) first checks are also obtained for all staff. However, in one staff file examined for a member of staff who was not British and had recently entered the country as a student, there was no copy of their work permit held on file. Ryton Towers DS0000007432.V336232.R02.S.doc Version 5.2 Page 22 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. This judgement has been made using available evidence including a visit to this service. The residents welfare is promoted by a well managed home, however there are some risks to health and safety which need to be addressed. Recording procedures do not fully 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. Ryton Towers DS0000007432.V336232.R02.S.doc Version 5.2 Page 23 EVIDENCE: The manager has many years experience at a senior level within the organisation and has managed this home since January 2006. She has attained a number of care and management qualifications including 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, such as equality and diversity as well as training in health and safety matters, to ensure that her knowledge is kept up-to-date. Staff and residents said that they found the manager to be very approachable. The manager is supported and supervised by an area manager, and there are clear lines of accountability within the organisation. The area manager regularly visits the home, and was visiting at the time of the inspection. She makes her self known to residents and visitors and asks for their views about the service. She also completes a thorough monthly audit of the service. The organisation has a comprehensive quality assurance system that includes a number of audits of the homes practices, and also includes the views of residents. There are regular residents meetings where residents are able to voice their ideas, comments and suggestions. Satisfaction questionnaires are also used to gain the views of residents and relatives. There is no annual development plan available, which would be good practise as this would show relatives, residents and other stakeholders whether or not the service is meeting its stated aims and objections. The personal allowance records showed that receipts and double signatures are maintained for all transactions. The manager checks these each week and a sample checked every month by the area manager. The home purchases toiletries in bulk so that residents can buy these items if they run out of them. A handwritten receipt is given to the residents if they purchase anything from the home’s supply, however, details of each item are not recorded on the handwritten receipt with only the word “toiletries” and the total cost of these recorded. The original receipt for the bulk purchase is also not maintained, which would be good practise. Staff receive regular training in relation to health and safety matters. An appropriate record of accidents is maintained which includes any action taken following the accident. The number of accidents in the home has increased from 9 in May to 20 in June and 19 in July 2007. The manager needs to develop an accident analysis tool so that she can identify if there are any themes or trends so that the number of these can be reduced. Ryton Towers DS0000007432.V336232.R02.S.doc Version 5.2 Page 24 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. A radiator in the corridor, which does not have a guaranteed low surface temperature, has not been fitted with a guard. There are maintenance staff to carry out routine maintenance checks and address any minor repairs. Water temperature checks are carried out to ensure that hot water to baths is at a safe temperature for residents to use. However, although records of these confirmed that sometimes the bathwater temperature was 46 degrees centigrade, no action had been taken to address this. Ryton Towers DS0000007432.V336232.R02.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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 2 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 2 X X 2 Ryton Towers DS0000007432.V336232.R02.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 OP7 Regulation 15 Requirement Residents 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, 30/09/06&30/11/06). The manager must ensure that residents receive their prescribed medication at all times. This is to ensure the residents health is fully promoted. The manager must ensure that residents are able to decide when they would like to have a bath. This is to fully promote their autonomy and choice. The manager must ensure that staff from overseas have been provided with a work permit and are legally entitled to work in this country. All staff must receive in-depth training in dementia so that they can effectively meet the needs of the residents. (Timescale not met 31/12/06) A system of accident analysis must be introduced in order to DS0000007432.V336232.R02.S.doc Timescale for action 31/07/08 2. OP9 13(2) 15/09/07 3. OP14 12(2) 30/09/07 4. OP29 19 15/09/07 5. OP30 18(2) 31/03/08 6. OP38 13(4)( c ) 31/10/07 Ryton Towers Version 5.2 Page 27 7. 8. OP38 OP38 identify how the frequency of these can be reduced. This is to fully safeguard the residents. 13(4) ( c ) Bathwater temperatures must be maintained at as close to 43 degrees centigrade as possible. 13(4)( c ) Guards must be fitted to all radiators which do not have a guaranteed low surface temperature. 15/09/07 30/09/07 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 OP9 Good Practice Recommendations The manager should see the original prescription issued by the GP. Photographs of residents should be available on the Medication Administration Record. A record should be maintained of all prescribed creams staff administer to residents. A record of the temperature of the medication room should be maintained. Staff administering medication should make sure that this has been taken by the resident before they sign the Medication Administration Record. The manager should make arrangements to ensure that staffing levels are maintained when she is on holiday. The home should produce an annual development plan. This so that information is available as to whether or not the service has met its stated aims and objectives. Handwritten receipts should provide details of each item purchased and the cost of these items. These should be cross-referenced to the original receipt obtained from the shop. This is to fully safeguard residents from financial abuse. 2. 3. 4. OP27 OP33 OP35 Ryton Towers DS0000007432.V336232.R02.S.doc Version 5.2 Page 28 Commission for Social Care Inspection South Shields Area Office 4th Floor St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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 Ryton Towers DS0000007432.V336232.R02.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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