Inspection on 23/10/07 for The Rubens

This inspection was carried out on 23rd October 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

The Rubens 07/03/07

The Rubens 26/09/06

The Rubens 17/03/06

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE The Rubens Pave Lane Newport Shropshire TF10 9LQ Lead Inspector Joy Hoelzel Key Unannounced Inspection 10:00 23rd October 2007 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 The Rubens DS0000064155.V348164.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Rubens DS0000064155.V348164.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Rubens Address Pave Lane Newport Shropshire TF10 9LQ 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 810400 01952 820698 United Care Ltd Ms Deborah Ann Aston Care Home 26 Category(ies) of Old age, not falling within any other category registration, with number (26) of places The Rubens DS0000064155.V348164.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th March 2007 Brief Description of the Service: The Rubens is a privately owned Residential Home, which opened as a care home in 1987, and is registered to provide personal care and accommodation for up to 26 older people. Situated in a semi-rural location, on the edge of the Shropshire Town of Newport, local amenities are available within a short drive. The Home is a conversion of a 19th Century building, with a purpose built extension added in 1999, and accommodation comprises mostly single bedrooms, 20 of which having en-suite lavatory and wash-hand basin facilities. There are a number of lounge/seating areas and one dining room. With pleasant gardens to the rear of the building many of the rooms benefit from extensive rural views. Information of the home and the provision of the service are available in the statement of purpose and service user guide, both documents have recently been revised and are readily available. The service user guide does not include information on the current level of fees for the service. The reader may wish to obtain up to date information from the care service. Commission for Social Care Inspection reports for this service are available from the provider or can be obtained from www.csci.org.uk The Rubens DS0000064155.V348164.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over five hours on Tuesday 23rd October with a short follow up visit on Tuesday 30th October 2007. It was conducted by one Commission for Social Care Inspection regulation inspector. The pharmacist inspector visited the home on the 29th October 2007 as part of the key inspection and carried out an inspection of the medicines management systems being practiced within the home. The pharmacy inspection looked at the effectiveness of the home’s arrangements for the receipt, recording, handling, storage, safekeeping, safe administration, and disposal of all medicines received into the home. The inspection comprised of examining the medication storage area, examining the records kept and having discussions with both the care staff and residents. The findings of the inspection were then fed back to the manager at the end of the visit. Twenty three of the thirty eight National Minimum Standards for Care Homes for Older People were inspected as they are viewed as key standards for services. Twenty one people are currently living at the home and during the inspection were observed to be accessing all areas of the home. The registered manager was on the premises supported by two care staff and two kitchen staff. The care provided for three people were examined in detail, relevant documents were inspected, discussions were held with people living at the home, visitors, members of staff and the manager. Observation was made of the various daily activities and a tour of the premises was conducted. Prior to this inspection an Annual Quality Assurance Assessment (AQAA) document was posted to the home for completion. The AQAA is a selfassessment and a dataset that is filled in once a year by all providers. It informs us about how providers are meeting outcomes for people using their service and is an opportunity for providers to share with the CSCI areas that they believe they are doing well. It is a legal requirement that the AQAA is completed and returned to the commission within a given timescale. The registered manager completed this document and returned it the commission. Comments from the AQAA are included within this inspection report. On site surveys were distributed during the inspection and completed by people living and working in the home. The comments received are included in this report. The Rubens DS0000064155.V348164.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: There is a variable standard of décor, furnishings and cleanliness in the home, with some areas requiring urgent attention. Generally the home is not clean and there are several areas that pose a risk to the people living, working and visiting the home. The Rubens DS0000064155.V348164.R01.S.doc Version 5.2 Page 7 Currently there are not enough domestic staff to keep the home clean and hygienic. The current reliance on care staff to undertake domestic and laundry duties in addition to their care tasks is detrimental to ensuring that the care needs of people to be fully met. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Rubens DS0000064155.V348164.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Rubens DS0000064155.V348164.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): OP 2, 3,6 Quality in this outcome area is good. Prospective service users have their care needs assessed before moving into the home and whenever possible have the opportunity to visit the home to assess its quality, facilities and ability to meet their needs prior to admission. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Details of the service provision are available in the statement of purpose and service user guide; both documents have been reviewed in February 2007, and are available on request. These documents were not inspected in depth on this occasion but on general observation the service user guide does not include information on the current level of fees for the service. To comply with the regulations the service user guide must include information about the fee levels and what are and are not included in the fees. The Rubens DS0000064155.V348164.R01.S.doc Version 5.2 Page 10 Three case files of people living at the home were selected for inspection and indicated that pre admission assessments and personal details had been sought prior to offering a placement at the home. The Annual Quality Assurance Assessment (AQAA) completed by the manager of the home specifies that whenever possible people are invited to visit the home prior to making the decision to move in. One person currently residing at the home stated that they decide to move in because of the close vicinity to their relatives. The home does not offer an intermediate care service. The Rubens DS0000064155.V348164.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): OP 7,8,9,10. Quality in this outcome area is good. The care plan is a working document that is reviewed regularly involving the person and their representatives if agreed. Significant improvements have been made to the procedures for administering medication, further checks are required to ensure the staff comply with the guidelines. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All people living at the home have a plan of care that is generated at the point of admission and reviewed at regular intervals. The person and/or their representative are involved in this procedure, all files looked at contained information and evidence of their inclusion. Three case files were selected for inspection and all included a full assessment of the activities of daily living. The care plan was then based on the specific issue, goals, action plan and review. The Rubens DS0000064155.V348164.R01.S.doc Version 5.2 Page 12 The care plans cover areas of healthcare including mobility, pressure area care, maintaining a safe environment, continence, nutrition and specialist interventions. One person was having difficulties with mobility due to a decrease in general health, a plan of care had been developed to give staff instructions on how to reduce the risk of this person falling and injuring him or herself. The general practitioner and district nurse had been contacted for assistance and guidance. Another plan gave staff specific instructions for assisting a person to ensure that their dignity and privacy was upheld when personal interventions were required. The policy and procedures for the handling of medicines had been updated and had been judged as comprehensive by a representative of the Medicines Management Team at Telford and Wrekin Primary Care Trust. The medication records had significantly improved. The quantities of medicines received were being recorded and medicines being carried over from the previous monthly cycle were also being taken into account. The problem of having a large number of missing signatures and undefined abbreviations in the administration records appeared to have been eradicated. The quantities administered for the variable dose medicines were being recorded and handwritten entries were being double checked for accuracy. The improvements in the records showed however that staff were on occasions still signing the Medication Administration Record (MAR) charts but not actually administering the medication. The manager expressed her disappointment by this and made assurances that this issue would be sorted out within 24 hours. The manager needs to put in place a programme for checking the authenticity of the MAR charts. The manager was also reminded to ensure that all handwritten entries on the MAR charts were double checked by another member of staff. The senior care staff that were responsible for administering medication to the residents were receiving medication handling competency assessments approximately every three months. These assessments had resulted in improvements in the record keeping, the administration process and the storage of medication. Although on observing the lunchtime round there appeared to be some handling of the medication and medication was being left unsupervised on the dining tables. The issue of sharing prescribed medicines between residents appeared to have been resolved. The Controlled Drugs cabinet had successfully been relocated from the home care office and the recording of the receipt and administration of the Controlled Drugs appeared to be satisfactory. The Rubens DS0000064155.V348164.R01.S.doc Version 5.2 Page 13 The home did appear to still be having difficulties with monitoring the fridge temperatures. The home was now recording a maximum and minimum temperature of the fridge on a thrice-daily basis but the records showed that the fridge temperature was not being maintained within the accepted temperature range. This issue was not looked at any further because the home did not, on the day of the inspection, have any medicines that required cold storage conditions. Medicated creams/ointments were not being stored in the residents’ rooms and medicines that had a short shelf life upon opening were being dated upon opening. The people living, visiting and working at the home appear to have developed good relationships with each other there was chatter and discussions occurring. Staff, although extremely busy, were observed to be offering choices with activities arranged, drinks and meals. Some people, particularly the gentlemen, looked a little unkempt in their appearance and seem to be reliant on staff to assist them with personal hygiene and grooming. It is acknowledged that some difficulties may arise from time to time during the course of the day; nevertheless staff should be in sufficient numbers to ensure that standards are maintained. The Rubens DS0000064155.V348164.R01.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): OP 12,13,14,15 Quality in this outcome area is good. People who live at the home are involved in meaningful daytime activities of their own choice and according to their individual interests and capabilities. The meals are balanced and nutritional and cater for the dietary needs of the individuals using the service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: In house and community based activities are organised by the care staff and can be either a group activity or on a one to one basis. The statement of purpose and service user guide detail the range of activities that are available During the morning of the inspection some people were enjoying a reminiscence session, some preferred to stay in their bedrooms, others were watching television, or just sitting watching the happenings of the day. One person made a comment in the on site survey that – The Rubens DS0000064155.V348164.R01.S.doc Version 5.2 Page 15 ‘We have a lovely lady who inspires us to have a go at making a variety of arty pictures and greeting cards’. Another person commented that they liked the – ‘ Quizzes, songs and reminiscence’. People spoken with said how much they enjoyed the gardens and that they went outside when the weather permitted. The home has an open visiting policy with people welcome to visit at times suitable to the person living at the home. During the tour of the premises many bedrooms contained personal possessions, one person stated that they were satisfied with their accommodation and had ‘no complaints’. People have the choice of where to take their meals but are encouraged to go to the dining room whenever possible. The dining room was well prepared in advance of the mealtime, with people being offered a pre dinner glass of sherry. A four weekly rotational menu is operable with the meal planned on the menu corresponding with the meal prepared. The cook stated that people have a choice of menu for all meals served during the day, and alternatives can be served if the menu is not to a person’s preference. One person confirmed that staff offer a choice of fare for dinner and tea and went on to say that they forget what they have ordered but that this is not a problem as they are fully satisfied with the meals that they get. Other people spoken with confirmed a satisfaction with the meals provided. The Rubens DS0000064155.V348164.R01.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): OP 16,18 Quality in this outcome area is good. The service has a complaints procedure with people living at the home confirming that they are aware of how to make a complaint and to whom. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a comprehensive complaints policy, which is included in the statement of purpose and service user guide. A copy is displayed in the entrance of the building. People spoken with said they didn’t have any complaints but would feel very comfortable to speak with the manager or any of the staff at any time. Two people living at the home completed the on site survey and indicated they were aware of how to make a complaint if they needed to do so, one went on to comment – ‘Matron has listened to me when I needed a helping hand, I have no complaints’. The manager discussed the three complaints received at the home since January 2007, which were investigated using the homes procedures. All of The Rubens DS0000064155.V348164.R01.S.doc Version 5.2 Page 17 which have reached a satisfactory conclusion with some amendments to working practice being made. Since the inspection in March 2007 five referrals have been made to the safe guarding adults team for investigation following allegations of abuse. Four of the five have reached a satisfactory conclusion, with the most recent allegation continuing to be investigated by the multi -agency team. The manager has offered her cooperation and assistance with the procedures by attending meetings and preparing reports. The multi- agency safeguarding procedures are available for staff reference and staff have received training this year in the protection of vulnerable adults. Some money is held for safe keeping on behalf of people who use the service. Two named people are responsible for maintaining the records and ensuring the safety of the money. Individual recording sheets are maintained with two people signing for each transaction, all receipts for expenditure are kept. The manager regularly audits the documents and checks for accuracy. The Rubens DS0000064155.V348164.R01.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): OP 19,21,22,24,25,26 Quality in this outcome area is poor. The home is not clean and tidy, domestic cleaning arrangements are not adequate and cleaning is often done by care staff. There are several areas that pose a potential risk to people living and working at the home e.g. the procedures for maintaining the safety of the equipment and infection control. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has developed a maintenance programme for the refurbishment and redecoration, and includes the replacement of the carpet in the corridors (Winter 2007), and the redecoration of all bedrooms (Winter/Spring 2007/08) to include new flooring in all bedrooms, some bedrooms had been completed. The Rubens DS0000064155.V348164.R01.S.doc Version 5.2 Page 19 During the tour of the premises, with the manager, there was a variable standard of décor, furnishings and cleanliness • Many of the armchairs in the small sitting area and private rooms need either replacing or a thorough cleaning; many were soiled with food or excrement, had odd cushions or were low and unsuitable for the client group. The aids around the toilets were rusty and need replacing to reduce the risk of injury. Extractor fans were not working in some toilets and en suites. The bath surface is badly damaged and is a potential infection control risk Wardrobes were not secured to the wall and have the potential of toppling over and causing injury. The alterations to the shower room are not complete; the home continues to be below the national minimum standard of having one bathing facility for every 8 people in residence. Many disposal bins were without lids and were not foot operated, this compromises infection control procedures. The upstairs sluice room, which is used to wash the commode bowls has only a domestic type sink, this is not conducive for effective infection control. Some beds, mattresses, bases and bed linen were soiled, stained and marked and in need of replacement. Bedrails in use on the beds are loose, not fitted correctly and could be easily moved up and down the bed, this has the potential for an entrapment incident occurring. All areas around the home are looking dirty and grubby and in need of attention and a thorough clean. Hot water outlets accessible to residents have not been fitted with pre set valves of a type unaffected by the changes in water pressure to prevent the risks from scalding. Requirements for valves to be fitted have been issued at the inspections in March and September 2006 with an assurance being given at the inspection in March 2007 that this requirement had been fully complied with. Random temperatures taken today (23/10/07), by the handy man ranged from 39.1 – 61.5 degrees Celsius. Immediate action was taken to reduce the risk of injury to the inhabitants of the bedrooms by turning off the water supply. The contractor was contacted and arranged to visit the home later on in the day. (30/10/07), was carried out to check that the risk of scalding had been reduced with the installation of the safety valves and found that the temperature was now at an acceptable level. The manager again offered her assurance that now all outlets accessible to residents had been fitted with the said valves. • • • • • • • • • • • The laundry floor has been replaced with an easily cleanable surface and The Rubens DS0000064155.V348164.R01.S.doc Version 5.2 Page 20 covers have been fitted to all radiators to reduce the risk of injury. The manager discussed the recent difficulties with maintaining the cleanliness of the building due to a shortage of domestic staff, one member of care staff had been allocated specific hours during the week to attend to cleaning and laundry tasks. Staff commented that they had to attend to the cleaning of the home in addition to their care duties and stated they are very busy at all times. People living at the home expressed a general satisfaction with their accommodation ‘Very happy to be in the home’ ‘No complaints about the cleanliness’ The Rubens DS0000064155.V348164.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): OP 27,28,29,30 Quality in this outcome area is poor. The current staffing levels are not sufficient to meet the needs of the people using the service, with the health and welfare of people being adversely affected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager was at the home and in charge of the premises on the 23rd October supported by three care staff and two kitchen personnel. Two extra care staff arrived at the home later on the morning, on a request for help from the manager, other staff commented this was unusual and was done for the inspection. There were no domestic or laundry personnel. The manager explained that the home had been short of ancillary staff for over a month; during this time the care staff had been doing these tasks. Recruitment for a domestic help of 30 hours a week had commenced with a person identified, a start date was imminent dependent on the necessary checks being satisfactory. At the follow up visit the manager confirmed that a person had started work on 29th October. The Rubens DS0000064155.V348164.R01.S.doc Version 5.2 Page 22 The manager stated that care staff would continue to help out with domestic and laundry tasks when needed in addition to their care duties. Observation of the cleanliness of the home, condition of personal clothing that had been laundered, and appearance of some of the people, clearly evidenced difficulties with the inadequate staffing levels over the last months. One member of staff spoken with stated ‘We are always very busy, there is not enough staff’. The Annual Quality Assurance Assessment completed by the manager documents that of the 15 permanent care staff only four have been accredited with National Vocational Qualification level 2 or above. The home should by now have achieved a ratio of 50 of trained care staff to ensure that suitably qualified, competent and experienced staff are working at the care home at all times The manager discussed the difficulties with recruiting and retaining staff and stated this is ‘mainly due to the location of the home and the current level of pay’. Records examined showed they contained all the necessary information, which demonstrates potential staff are well screened before they are deemed suitable to start work at the home. There was recorded evidence to show that staff had completed appropriate courses relevant to their level of training need in the core and specialist topic areas The Rubens DS0000064155.V348164.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): OP 31,33,35,38 Quality in this outcome area is adequate. The manager is endeavouring to improve and develop systems that monitor practice and compliance with the plans, policies and procedures of the home, however more work is needed in this area. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Deborah Aston has been the registered manager of the home for 18 months, and is currently studying for the Registered Managers Award. Mrs Aston works mainly in a supernumery capacity but assists with clinical and domestic duties when necessary. The Rubens DS0000064155.V348164.R01.S.doc Version 5.2 Page 24 Quality assurance and monitoring of the home continues, annual surveys and satisfaction questionnaires were distributed in October, a sample of the completed forms seen indicated a general satisfaction with the service. The home offers a facility for residents to deposit personal monies for safekeeping; records relating to this have been maintained and fully receipted. Documents are available to record the weekly, monthly and annual testing of equipment; the handyman states that he refers any problems encountered to the manager. There is evidence to suggest that not all problems reported have been actioned to remedy the problem and to reduce the risk of injury to people living at the home. The Rubens DS0000064155.V348164.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 3 X X N/a HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 2 11 X 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 2 X 2 X X 2 3 1 STAFFING Standard No Score 27 1 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 2 The Rubens DS0000064155.V348164.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP21 Regulation 23(2)(j) Requirement Bathing facilities must be provided in sufficient numbers for the people living at the home. Previous requirement with compliance date of 31/08/07 not met. All areas of the home should be maintained in a clean and hygienic condition. Staffing numbers must be maintained in sufficient levels to ensure that the health, personal and social care needs of all people living at the home are fully met. Domestic staff should be employed in sufficient numbers to ensure that standards of cleanliness are maintained and that the home is in a hygienic and clean state. Timescale for action 30/11/07 2 3 OP26 OP27 23(1) 18(1) (a) 30/11/07 30/11/07 4 OP27 18(1)(a) 30/11/07 The Rubens DS0000064155.V348164.R01.S.doc Version 5.2 Page 27 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 2 3 Refer to Standard OP1 OP9 OP9 Good Practice Recommendations To comply with the regulations the service user guide should include information about the fee levels and what are and are not included in the fees. The registered person should carry out spot checks on the MAR charts to ensure that the MAR charts are accurate and authentic. The registered person instructs staff on how to use the maximum and minimum thermometer properly and thus ensures that the fridge temperature records are accurate and the fridge is maintained at the correct temperature. Arrangements are to be developed and implemented to ensure that people live in a safe, well-maintained environment. All equipment used at the home must be clean, well maintained and fit for the purpose. The wardrobes provided by the home should be securely fixed to ensure the safety of people living, working and visiting the home. The home must achieve a ratio of 50 of trained care staff to ensure that suitably qualified, competent and experienced staff are working at the care home at all times The registered manager must complete the Registered Managers Award to ensure that she develops the knowledge base to successfully manage the home. 4 5 6 7 OP19 OP22 OP24 OP28 8 OP31 The Rubens DS0000064155.V348164.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Shrewsbury Local Office 1st Floor, Chapter House South Abbey Lawn Abbey Foregate SHREWSBURY SY2 5DE 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 The Rubens DS0000064155.V348164.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!