Inspection on 26/09/06 for The Rubens

This inspection was carried out on 26th September 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 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 23/10/07

The Rubens 07/03/07

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 26th September 2006 09:50 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.V307511.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.V307511.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 810400 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.V307511.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 17th March 2006 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 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. Weekly fees range from £352.44. 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. 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.V307511.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection is the first of key inspections for 2006/07 and took place over five hours on Tuesday 26th September 2006. It was conducted by one Commission for Social Care Inspection regulation inspector. Twenty three of the thirty eight National Minimum Standards for Older People were inspected. Twenty five people are currently living at the home, one person is presently in hospital, and throughout the time of the inspection residents were observed to be accessing all areas of the home. A manager was on the premises in charge of the building and was supported by two care staff with additional domestic and catering staff. Three case files were selected for case tracking, relevant documents were inspected and discussions were held with residents, visitors and members of staff. Observation was made of the various daily activities and a tour of the premises was conducted. What the service does well: What has improved since the last inspection? The recently refurbished dining area is very comfortable and homely. The manager discussed the ongoing plans for further improvements to be made to the environment and the equipment to be purchased later on in the financial year. The Rubens DS0000064155.V307511.R01.S.doc Version 5.2 Page 6 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. The Rubens DS0000064155.V307511.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Rubens DS0000064155.V307511.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): OP 3,6 Quality in this area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents have their care needs assessed before moving into the home. Relatives, and whenever possible the person requiring care, are provided with the opportunity to visit the home to assess its quality, facilities and ability to meet an individual’s needs prior to admission EVIDENCE: A full assessment of a persons care needs is carried out by a member of staff and received from the appropriate healthcare agencies, prior to offering a placement at the home. The case file of the person most recently admitted to the home contained a personal profile and an assessment of daily living and needs assessment. Relatives and residents spoken with confirmed that they were invited to visit the home prior to making the decision to move in and had the opportunity to meet with staff and other residents. The home does not offer and intermediate care service The Rubens DS0000064155.V307511.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): OP 7,8,9,10 Quality in this area is adequate. This judgement has been made using available evidence including a visit to this service. Each resident has a care plan; the practice of involving residents in the development and review of the plan is variable. The plan in most cases includes the basic information necessary to plan the individuals care, some omissions of recording information has the potential for not fully meeting a persons needs. EVIDENCE: Three case files were selected for inspection one being of the person most recently admitted to the home, the others had been at the home for a period of time. Each resident has a plan of care based on the activities of daily living and needs assessments; one plan had a comment that due to cognitive difficulties the resident was unable to take part in the care planning procedures. A relative of another resident stated that no opportunity had been offered to formally assist and agree the care plan but many informal chats happen with the staff to discuss the care offered. None of the three plans inspected were being reviewed on a monthly basis. The Rubens DS0000064155.V307511.R01.S.doc Version 5.2 Page 10 The care plan of one person had not been fully reviewed when a change in condition had been identified. An assessment for maintaining skin integrity and for the prevention of developing pressure areas has not been completed. The interventions, (pressure area care, two hourly turns, offering fluids and diet), carried out by the care staff are not being adequately recorded to inform other staff of the care offered during the day and night. However during the inspection staff were observed to be regularly visiting this person to ensure the care needs were met. The relative of this person spoke very highly of the care on offer and stated that ‘ the very best of care is being given, my relative is comfortable and serene’. One care plan identified a person with a low body weight with the instruction ‘to monitor carefully’ being made in the plan. A nutritional risk assessment had not been carried and there was no evidence of regular weight recording or any instructions for staff when the use of food supplements or contact with dieticians are required. A book is maintained for recording the visits of GP’s, chiropodists and other visiting health care professionals. The home operates a twenty eight day regimen for the administration of medication using the monitored dose with the additional use of some bottles and boxes. A senior care staff member demonstrated a good knowledge of the procedures and explained the systems for recording receipt and disposal of medications each month. Surplus medications are stored in a locked cupboard in the main office. It was recommended to the manager that a lockable cabinet and appropriate book be purchased to ensure the safe storage of the controlled drugs that are prescribed for some residents. The fridge used for the cool storage of medications recorded a temperature of 14.9 degrees Celsius. For the safe storage of medications the temperature must be maintained at between 2- 8 degrees. Records are not kept of the temperature on a daily basis and staff were unsure for how long the temperature was high. The staff were informed to discard all medications in the fridge as the integrity of the medications could not be guaranteed. The manager acted immediately and ordered a new fridge, controlled cabinet and controlled drugs book. The external products were also not being dated upon opening and the home was advised introduce this practice and discard tubs after one month of opening and tubes after 3 months of opening. Eye drops must be discarded after being open for twenty eight days. The care staff were observed to be assisting service users with personal care discreetly and in a manner which promotes service users’ dignity. The Rubens DS0000064155.V307511.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): OP 12,13,14,15 Quality in this area is good. This judgement has been made using available evidence including a visit to this service. The daily living and social activities arranged for service users takes into account the differing expectations, preferences, lifestyle and capacities of each individual. EVIDENCE: The daily activity programme is displayed on the notice boards around the home; during the afternoon a movement to music session was arranged. Residents spoken with stated that they enjoyed this as ‘ it kept them going’. Religious services are arranged monthly with the opportunity for receiving communion. Residents in the quiet lounge stated that they spent their day conversing with each other and generally watching the world go by. The hairdresser was on the premises and busy with the ladies and gentlemen. A visitor arrived during the morning with the ‘pat’ dog; all residents appeared to enjoy this contact with the dog. Many visitors were at the home and stated that they are welcomed by the staff and were able to visit at times suitable for the relatives. One relative visited most days to help with the midday meal and confirmed that she enjoyed this time she was able to spend with her relative. The Rubens DS0000064155.V307511.R01.S.doc Version 5.2 Page 12 The statement of purpose includes information on the arrangements for maintaining contact with relatives, friends and representatives. During the tour of the premises many of the bedrooms were individualised with personal belongings. Staff were observed to be offering choices to service users throughout the day, the choices and options very much dependent on the capacity of the individual. The cook demonstrated a good knowledge of the personal preferences of the diet of the residents, and stated that currently no special diets are required. The home does not operate a menu offering s choice of meals the cook stating that the food is prepared each day and she ‘knows what each person likes’. To aid the planning of meals it is recommended that a four weekly menu in written or other formats be developed offering choice and variety of meals. A plan had been made for the kitchen to be painted, the midday meal of fish and chips being organised from the local chip shop. One resident who requires a soft diet was having some difficulty with the meal; this was discussed with the manager at the time. A glass of sherry was offered prior to serving the meal. Residents stated that the food is ‘always lovely’. Staff were observed to be assisting the more frail people with their meal in an unhurried and relaxed manner. The dining room has recently been redecorated with new table linen purchased and now provides an extremely attractive area for dining. The Rubens DS0000064155.V307511.R01.S.doc Version 5.2 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): OP 16,18 Quality in this area is good. This judgement has been made using available evidence including a visit to this service. The complaints procedure is widely distributed, and has a high profile within the service. Residents and others associated with the home demonstrate a good understanding of how to make a complaint and they are very clear of what can be expected to happen if a complaint is made. EVIDENCE: The statement of purpose and service user guide both contain information on how to make a complaint. The Shropshire Complaint and Representative Procedures and Client Complaint forms are available at the entrance of the home. The manager stated that one complaint has been received since the inspection in March 2006,the social worker has been notified and the complaint is ongoing. The Commission for Social Care Inspection have not received any complaints/ concerns regarding the service since the previous inspection. The complaint and adult abuse procedures have both been recently reviewed (February 2006). Staff demonstrated a good knowledge of the procedures for dealing with service users personal monies kept at the home for safekeeping. Two staff were observed to be carrying out an audit to ensure the accuracy of the amount stated on the recording sheet and the actual amount of cash held. The Rubens DS0000064155.V307511.R01.S.doc Version 5.2 Page 14 It is recommended that receipts are given and obtained for each transaction and that two people sign the recording sheet. The service user guide details the maximum of amount of money that can be deposited for safekeeping. The Rubens DS0000064155.V307511.R01.S.doc Version 5.2 Page 15 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): OP19, 25,26 Quality in this area is adequate. This judgement has been made using available evidence including a visit to this service. The service provides a homely environment and has benefited from some redecoration and refurbishment. There are one or two areas that pose a potential risk to residents, for example, some radiators are not guarded, and water may be very hot coming from a tap due to a lack of a safety valve. The timescales for action to reduce the potential risks to residents have not been complied with. EVIDENCE: The home offers a variety of private and communal accommodation; the manager explained the recent redecoration and refurbishment of some areas around the home and discussed the future plans. During the tour of the building some doors were being wedged open by wooden blocks or pieces of furniture. The doors having the written instruction of ‘Fire Door – Keep Shut’. The Rubens DS0000064155.V307511.R01.S.doc Version 5.2 Page 16 If it is a person’s preference or there is an assessed need for the doors to remain open then the appropriate door closures must be installed. The temperatures of the hot water outlets accessible to residents were randomly tested with the temperatures ranging from 34 – 51 degrees Celsius. The manager explained that the thermostatic valves had been purchased but had not been fitted. A plumber was contacted and called during the afternoon to attend to the areas where a very high temperature was identified. The valves could not be fitted by the plumber at the time therefore the three areas that posed the most risk to residents were taken out of use. Two requirements in relation to maintaining a safe hot water temperature were made at the last inspection these have not been complied with, the registered person must now take immediate action to ensure that the risk of scalding is reduced. The radiators in the older part of the building have not been changed to low surface temperature types, to reduce the risk of burn injuries to the people within the area. This was a requirement following the last inspection (March 2006); the agreed timescale has not been met. For the effective control of infections suitable hand wash facilities have been installed in each area where personal care is delivered. The manager confirmed that the purchase of an automatic sluice disinfector is planned for later this year. The Rubens DS0000064155.V307511.R01.S.doc Version 5.2 Page 17 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): OP 27,28,29,30 Quality in this area is good. This judgement has been made using available evidence including a visit to this service. The service has a good recruitment procedure that clearly defines the process to be followed. This procedure is followed in practice with the service recognising the importance of effective recruitment procedures in the delivery of good quality services and for the protection of residents. EVIDENCE: A rota is maintained of the numbers of staff on duty over the twenty four hour period. Usual levels are arranged with one senior and two care staff during the day reducing to one senior and one care staff as waking night staff. The manager confirmed that she is mainly supernumery to these levels. Ancillary staff are additional. Three staff personnel files were selected for inspection all the necessary identity checks have been carried out, with records kept. Training opportunities continue in the core and specialist topic areas for all staff. Certificates and records of achievement are retained in the personnel files. The statement of purpose details the organisational structure and the number, qualifications and experience of staff. The Rubens DS0000064155.V307511.R01.S.doc Version 5.2 Page 18 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): OP 31,33,35,38 Quality in this area is good. This judgement has been made using available evidence including a visit to this service. The manager has the required qualifications and experience and is competent to run the home. She works to continuously improve services and provide an increased quality of life for residents. EVIDENCE: Since the last inspection in March 2006 a person has been recruited for the position of registered manager at the home and has successfully been through the formal interview procedures. Systems for the monitoring of the quality assurance of the service provision are on going with resident questionnaires being drafted and reviewed. Tenant consultation meetings with residents and their representatives are held every six months, the content being minuted and any concerns/ suggestions implemented. The monthly unannounced visits by the registered provider or a The Rubens DS0000064155.V307511.R01.S.doc Version 5.2 Page 19 person within the company are not being conducted on a regular basis as part of the monitoring systems. Staff demonstrated a good knowledge of the procedures for dealing with service users personal monies kept at the home for safekeeping. Two staff were observed to be carrying out an audit to ensure the accuracy of the amount stated on the recording sheet and the actual amount of cash held. It is recommended that receipts are given and obtained for each transaction and that two people sign the recording sheet. Records are kept of the routine testing of the fire alarm, emergency lighting and fire extinguishers. The testing for legionella has not been carried out and is outstanding. The Rubens DS0000064155.V307511.R01.S.doc Version 5.2 Page 20 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 3 10 3 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 X X X X 2 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 2 The Rubens DS0000064155.V307511.R01.S.doc Version 5.2 Page 21 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(2)(b) Requirement All care plans must be reviewed at least monthly or more frequently when a change of need has been identified. All assessments required to adequately meet a persons needs must be fully completed and reviewed at regular intervals. The registered person must ensure that the appropriate door closures (linked into the fire alarm system) are fitted to doors where there is a need or preference for the doors to remain open. The registered person must ensure that all hot water in areas accessible to service users must be regulated so that the maximum temperature is around 43 Degrees Centigrade. Previous timescale 30/04/06 not met To remove the risk of burning by unprotected radiator surfaces by installing protective covering, or replacement with radiators, which have suitable ‘cool’ DS0000064155.V307511.R01.S.doc Timescale for action 04/11/06 2 OP8 17(1)(a) Schedule 3 (o) 23(4) 04/11/06 3 OP19 04/11/06 4 OP25 13. (4)(a)(c) 04/11/06 5 OP25 13. (4)(a)(c) 04/11/06 The Rubens Version 5.2 Page 22 surfaces. Previous timescale 30/04/06 not met 6 OP33 26 The registered person must 30/11/06 ensure that a monthly unannounced visit to the home is conducted and a report is available for inspection. The registered person must 04/11/06 ensure that procedures are adopted for the regular testing of legionella. 7 OP38 13(4) 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 It is recommended that all external medications are dated upon opening with tubs of creams/ointments discarded after one month of opening and tubes after 3 months of opening. It is recommended that receipts are given and obtained for each financial transaction relating to the safe keeping of a residents personal money and that two people sign the recording sheet. 2 OP35 The Rubens DS0000064155.V307511.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Shrewsbury Local Office 1st Floor, Chapter House South Abbey Lawn Abbey Foregate SHREWSBURY SY2 5DE National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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