Care Home: Rakelands Nursing Home

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What the care home does well The home`s admissions process ensures that people who may wish to use the service have the best possible opportunity to judge whether the home is the right one for them. The care and support that people are given at Rakelands is personal to them as individuals. The home carries out assessments of people`s needs and ensures that the plan of care and support that is developed takes account of risks and meets their needs and goals. People are encouraged and supported to be as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. The homes` environment and facilities make the most of those opportunities. What has improved since the last inspection? Since the home was last inspected the following improvements have been carried out: The `Person Centred` approach to care and support has been developed, especially with regard to activities plans, and will be carried forward to all personal care support plans. The home has extended its range of outings into the community and promoted individual choices for holidays i.e. day holidays for one week or 5 day holidays away from home. The complaints procedure has been developed and a new format produced, so as to be more accessible to people with learning disabilities. 60% of staff are up to date with training in safeguarding vulnerable adults. Staff training is ongoing with additional training in communication skills, so they can effectively communicate and identify service users` needs. Hallways, lounges, both offices, two bedrooms and all corridors have been redecorated. What the care home could do better: There were no requirements or recommendations identified during the inspection. CARE HOME ADULTS 18-65 Rakelands Nursing Home London Road Rake Liss Hampshire GU33 7PH Lead Inspector Neil Kingman Unannounced Inspection 20th February 2008 10:00 Rakelands Nursing Home DS0000011536.V357025.R01.S.doc Version 5.2 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 Rakelands Nursing Home DS0000011536.V357025.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 Adults 18-65. 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. Rakelands Nursing Home DS0000011536.V357025.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Rakelands Nursing Home Address London Road Rake Liss Hampshire GU33 7PH 01730 894621 01730 890036 rakelands@robinia.co.uk 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) Robinia Care Ltd Mrs Virginia Tamba Care Home 16 Category(ies) of Learning disability (0) registration, with number of places Rakelands Nursing Home DS0000011536.V357025.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home with nursing only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Learning disability (LD) The maximum number of service users to be accommodated is 16. Date of last inspection 14th November 2006 Brief Description of the Service: Rakelands is a residential care home providing nursing care and accommodation for up to sixteen younger adults with learning and physical disabilities. The home is a large detached property set back in extensive grounds off the main London Road on the outskirts of a village called Rake, which has a village shop, post office and garden centre. Mrs Tamba manages Rakelands on behalf of the proprietors Robinia Care Limited, a national company who own a number of care homes within Hampshire. In addition to a residential nursing care service the home provides day service facilities, which include physiotherapy, horticulture, music therapy a sensory room, cookery, and a craft room. There is a hydrotherapy pool and a large trampoline on site, which people who live in the home use on a regular basis. Current fees range from £1200 to £1600 per week. Rakelands Nursing Home DS0000011536.V357025.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report details the results of an evaluation of the quality of the service provided by Rakelands and brings together accumulated evidence of activity in the home since it was last inspected on 14 November 2006. Part of the process has been to consult with people who use the service. To this end we have received written responses to several surveys, i.e., three from people who live in the home, completed with the aid of their key support workers and two from health and social care professionals. Information was also gained from the home’s file’ which contains notifications of incidents in the home. Included in this inspection were unannounced site visits to the home over two days by an inspector. The registered manager Mrs Tamba was available throughout the days. At the visits we had an opportunity to speak with staff on duty, and meet with the residents and two visitors. We also toured the building and looked at a selection of records. Prior to the site visit the manager sent to the Commission a detailed selection of information about the service including an Annual Quality Assurance Assessment (referred to as ‘the assessment’ during the report), which has been used with other information to inform the various judgements made about the service. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. What the service does well: The home’s admissions process ensures that people who may wish to use the service have the best possible opportunity to judge whether the home is the right one for them. The care and support that people are given at Rakelands is personal to them as individuals. The home carries out assessments of people’s needs and ensures that the plan of care and support that is developed takes account of risks and meets their needs and goals. People are encouraged and supported to be as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. The homes’ environment and facilities make the most of those opportunities. Rakelands Nursing Home DS0000011536.V357025.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Rakelands Nursing Home DS0000011536.V357025.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Rakelands Nursing Home DS0000011536.V357025.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 – People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. EVIDENCE: Pre-admission assessment People should know that their needs will be met when they move into a home. An important part of ensuring this happens is the pre-admission assessment. In order to assess the standard of the home’s admissions procedure we looked at how they managed the process for the most recently admitted person, who moved into the home in November 2007. In describing what typically happens the manager showed a good understanding of the importance of a thorough pre-admission assessment in the process of choosing the right home. She said that in normal circumstances she would visit the individual concerned and carry out an assessment of needs before any other part of the process took place. However, on this occasion she was unable to do so. In terms of outcomes this was not considered to be a concern as the manager explained that: Rakelands Nursing Home DS0000011536.V357025.R01.S.doc Version 5.2 Page 9 • • • • • She knew the person who wanted to use the service from previously working with them, and was familiar with their needs. The person’s family visited the home in advance of the admission to view the accommodation and facilities. A planning meeting was held to ensure that the move would be good for the individual and well supported by the service. There followed a series of introductory visits including a weekend stay to provide an opportunity for the person to meet with others who live in the home, and to judge whether the home would be suitable. The individual already had a friend who lives at Rakelands. We noted that an assessment of needs was on this person’s file as were assessments on a sample of two other files we looked at. The response to the care managers survey indicated the service always ensures that accurate information is gathered and that the right service is planned and given to individuals. Provider’s Annual Quality Assurance Assessment The assessment identified what the service does in this area: • • We recommend all potential service users and relatives to visit our home to assess our facilities and their suitability. The pre-admission process ensures that the correct choice of home is made and the service user is encouraged to have as much input as possible in the process, to ensure their preferences are incorporated in their care plan. There is a trial and monitoring visits to ensure the service meets client’s needs, and for the service user to make an informed choice. Statement of Purpose and Service User’s Guide given to prospective clients, which are both available in written form and in picture symbols. A written and costed contract/statement of terms and conditions between the home and the service user is developed and agreed with prospective service user. • • • Rakelands Nursing Home DS0000011536.V357025.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 - People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples’ needs and goals are met. The home has a plan of care and support that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, and have support with their finances. This is because the staff promote their rights and choices. EVIDENCE: Personal plans and risk taking – Each person living in the home has a personal plan of care and support. During the site visits we looked at a sample of three plans. The home is developing a person centred approach to planning the delivery of care and support to service users. This was best seen in their ‘health action plans’ and ‘activities plans’ in which information is set out in the ‘first person’ and accompanied by pictures and symbols. The manager said that this format would be developed more fully in the care support plans over the coming months. It was understood in discussions that a new operations manager is Rakelands Nursing Home DS0000011536.V357025.R01.S.doc Version 5.2 Page 11 monitoring to ensure there are no institutional practices and that people are given choices in their lives. Care planning contains information about health and care needs, about likes and dislikes and communication methods. They include risk assessments with clear guidance for staff on how risks are to be managed and minimised, and various protocols around the use of specialist equipment. Care plans and risk assessments are regularly reviewed and any changes are recorded. Daily records are completed and records of any accidents that occur. In discussions with the manager and staff it was clear that the home has a commitment to supporting people to maintain their independence and enabling them to take risks safely. Decision making The very complex needs of those who use the service mean that they need, and receive support to help them make decisions in their lives. Information in personal plans and discussions with staff on duty provided evidence of the extent to which staff go to make residents’ lives varied and worthwhile. The information about how best to support and communicate with people is a good example. We had an opportunity to spend time with the residents during the site visits. They were noted to be very well kempt and relaxed in the familiar surroundings of the home. It was understood in discussions with the manager that all people who use the service have a family member to represent them. In the event that an individual had nobody independent of the home to represent them the manager showed an understanding of how to access an advocacy service to ensure that their rights as individuals are protected. Two responses to the service users survey indicated they are sometimes able to make decisions about what they would like to do during the day and one indicated always. One indicated they are always able to make decisions about their daily routine and one that they can decide whether or not they would like to go out. Provider’s Annual Quality Assurance Assessment The assessment identified what the service does in this area: • Service users have an individual care plan, which reflects their assessed and changing needs, as well as their personal goals. The plan includes treatment, rehabilitation services and facilities to be provided by the home. Health action plans are in place for each service user. DS0000011536.V357025.R01.S.doc Version 5.2 Page 12 Rakelands Nursing Home • • • • The home has now started implementing PCP plans, which respect service user’s rights to make decision through an assessment process, which involves them. Risk assessments on day-to-day activities are in place. The home supports service users to take risks with their day-to-day activities as part of a more independent life style. We intend in the coming year to ensure that all staff receive training in Person Centred Planning by June 2008. We could do better to ensure that all staff have Makaton, Intensive Interaction training to further enhance communication with service users. Rakelands Nursing Home DS0000011536.V357025.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 - People who use the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal and family relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. Rakelands Nursing Home DS0000011536.V357025.R01.S.doc Version 5.2 Page 14 EVIDENCE: Leisure, community links, social inclusion and relationshipsThe manager said that while people who use the service have varying levels of ability due to profound learning and physical disabilities none has the capacity to develop employment skills or to take up opportunities for paid, supported or volunteer jobs. There was evidence during the inspection that the home promotes the individual’s right to live a meaningful life, both in the home and in the community. The service has a new activities co-ordinator and good on-site facilities to provide a range of activities that people can access with support from the staff. Activities plans give information about leisure choices and preferences. They are person centred and information is set out in an easy-read format with pictures and symbols. The manager said that they were undertaking work with the activities co-ordinator to more readily recognise whether people enjoy the activities on offer. They see this as important with so many individuals without verbal communication. Residents enjoy going out from the home, either to the Grove Resource Centre or to the shops, cinemas, theatres and other places of interest and entertainment either with staff from the home or with family members. Much use is made of the facilities, which are on site in the grounds of the home, including a hydrotherapy pool and sensory room with waterbed, which is of particular benefit to those with sight and hearing impairment. People maintain contact with their families to varying degrees and family and friends are not only made welcome at anytime they are actively involved with developing the service, e.g., work on one area of the garden. Visitors can meet with people in their rooms or any of the communal areas. There are quiet facilities available for private meetings and consultations. Daily routines Bedrooms were seen to be very well personalised and reflected residents’ different interests, personalities and preferences. A good deal of thought has gone into decorating each person’s room in a way that reflects their individuality. Staff respect peoples’ privacy and were seen to knock before entering their rooms. Communication is very good as we observed from interactions between staff and residents during the afternoon. It was clear that the residents hold staff in high regard. Rakelands Nursing Home DS0000011536.V357025.R01.S.doc Version 5.2 Page 15 No residents have the physical and cognitive ability to perform household tasks. All areas of the home are ‘wheelchair friendly’ and are accessible to the people who live their, including the grounds, which are spacious and well tended. Meals – The manager explained that due to the assessed needs of the residents many have their food liquidised. Five people have a specialist feeding method to ensure they receive the right nutrition for their health. In discussions about the food the manager said that one individual is currently experiencing difficulty with their intake of food, which is the subject of ongoing monitoring and review. Menus show that people are offered a variety of nutritious meals, which includes a vegetarian alternative. Each person has a meal chart in their care plan to record outcomes about whether they liked the meal or not. Provider’s Annual Quality Assurance Assessment The assessment identified what the service does in this area: • At Rakelands we strive to create a home where in comfort, safety and security the service user can be the individual they want to be. We offer support to help maximise personal potential by promoting independence in the light of individual needs, in particular ‘physical and profound learning difficulties’. The home has a happy atmosphere that is welcoming to all visitors. The routines of the home are flexible and based on a person centred approach to care. Staff support service users to access the Grove Resource Centre from Tuesday – Friday, where they take part in planned life skills activities. Our home has a Day Centre with a physiotherapy room, art room and kitchen, a ‘ snoozeleen’ room for relaxation and a hydrotherapy pool. The Day Centre is manned by a full time activities co-ordinator who coordinates a range of activities in and out of the home, with the help of a Company Occupational Therapist. The programme is devised in consultation with the service users, key workers and relatives. Staff assist the service users to access the community for leisure activities like cinemas, theatres, carriage horse riding. Staff encourage family and friends to be involved in daily routines and taking service users on outings. Staff use service users preferred form of address. Staff always engage with service users. Service users have unrestricted access to the home. Some service users are driven home for monthly visits to see relatives, thus maintaining family links and friendships. DS0000011536.V357025.R01.S.doc Version 5.2 Page 16 • • • • • • • • Rakelands Nursing Home • • • There are Regular local church visits from the Church of England. Some service users access the community using the train, taxis especially when they go shopping in London. All service users go on an annual residential holiday where they are further exposed to forming new friendships in a relaxed environment. Rakelands Nursing Home DS0000011536.V357025.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 - People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive personal care and support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. People cannot manage their medicine; therefore the care home supports them with it in a safe way. EVIDENCE: Personal support and healthcare– At the time of the inspection there were fifteen people resident at Rakelands and all require support in all aspects of their daily lives. Each person has a Health Action Plan, which clearly records individuals’ personal and healthcare, including physical, emotional and psychological needs in pictorial format, detailing how they prefer their support to be delivered. A physiotherapist is available on site to work with the residents in facilities dedicated for the purpose. Rakelands Nursing Home DS0000011536.V357025.R01.S.doc Version 5.2 Page 18 Staff use a person centred approach to the delivery of care and support and to meet people’s changing needs, e.g., those with severe mobility difficulties have speciallist equipment, and need individual approaches to managing their mobility. The home has been able to meet peoples’ specialist needs with hoists, including those that track from the ceiling, specialist wheelchairs, shower trolleys and an assisted bath to help staff to transfer them safely. In discussions with individual staff members it was clear that they have a good understanding of residents’ needs. The home uses sensory equipment to provide a relaxing and stimulating experience for people with complex needs. A comment in the survey for visiting health professionals gave a recommendation that staff would benefit from training in the daily oral healthcare of people with learning disabilities. This was fed back to the manager. The same response praised the staff for their interpersonal skills and general hygiene and nutritional requirements. Medication We looked at the home’s arrangements for residents’ medication with the manager. Records showed that medication is administered by staff who have been trained in medicines management and deemed competent by the manager. At the time of the site visit residents’ medication was securely held, and records relating to its safekeeping and administration were found to be in good order. Peoples’ assessed needs are such that staff administer all of their medication for them. Provider’s Annual Quality Assurance Assessment The assessment identified what the service does in this area: • Formulating some Health Action plans where the service user’s physical, emotional and psychological needs are effectively met. Service users are registered with various specialists, e.g. Physiotherapist, Psychiatrist, Psychologist, Speech and Language Therapist, Occupational Therapist, for all their various individual needs, i.e. communication, behaviour management, position and mobility. Implementing a person centred mode, which has enabled service users to receive personal support in the way they prefer and require. All service users are risk assessed to have medication retained, administered and controlled by nurses as they have limited resourced • • Rakelands Nursing Home DS0000011536.V357025.R01.S.doc Version 5.2 Page 19 due to their profound learning difficulties. This complies with the home’s policies and procedures, for dealing with medicines. Rakelands Nursing Home DS0000011536.V357025.R01.S.doc Version 5.2 Page 20 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 - People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. EVIDENCE: Complaints The home has a formal complaints policy and procedure details of which can be found in the service user’s guide. A copy of the procedure is displayed in the entrance hall. The procedure has been developed and a new additional format produced, so as to be more accessible to people with learning disabilities. Care support workers spoken with were clear about the procedure and showed a good understanding of how; through non-verbal signs they could tell if certain people were unhappy. Family members maintain a close liaison with the home and are encouraged to raise concerns with the manager who takes complaints seriously and deals with them correctly. A copy of the complaints register was available for inspection. The home’s assessment confirmed that two complaints have been made about the service in the last year, both of which were investigated and upheld. Rakelands Nursing Home DS0000011536.V357025.R01.S.doc Version 5.2 Page 21 Safeguarding adults Information provided as part of the home’s assessment indicated that policies, procedures and codes of practice are in place in the area of safeguarding adults and the prevention of abuse. Records showed that staff receive specific training in the subject. Staff spoken with confirmed that they had received training in safeguarding adults and were very clear about the importance of reporting issues of concern without delay. Since the last inspection there has been one safeguarding of adults referral, which was dealt with appropriately by the home. The matter was investigated by social services and recommendations made to the home. We noted during the site visit that the recommendations had been met. The home provides a secure system of safeguarding service users’ monies, which is regularly audited. The arrangements were fully explored and judged to be appropriate. Provider’s Annual Quality Assurance Assessment The assessment identified what the service does in this area: • Rakelands objective is to provide a high standard of individual care to all our service users. However should the service user, their family or advocate have cause to complain we urge them to speak to us about it immediately. Complaints whether verbal or written, are taken very seriously and will be thoroughly investigated. The complaints procedure is on display at the main entrance notice board, and in the service user’s Guide. All complaints are logged in the complaints register and signed off by the manager, when actioned. All prospective staff are POVA checked before commencement of any duties. On induction all staff receive training in protection of vulnerable adults and then yearly updates. All staff are aware of the whistle blowing procedure and who to talk to if they have any concerns. All staff are aware of the policy of handling service user’s finances and belongings. • • • • • • Rakelands Nursing Home DS0000011536.V357025.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 - People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People stay in a safe and well-maintained home that is clean, comfortable, pleasant and hygienic. There is enough space, and facilities for them meet their needs. The home makes sure people have the right specialist equipment that encourages and promotes their independence. Their rooms are comfortable and they feel safe when they use them. People have enough privacy when using toilets and bathrooms. EVIDENCE: Premises The home provides a physical environment that is generally suitable for the specific needs of the people who live there. As described earlier in the report specialist aids and equipment are provided to meet peoples’ needs. At the site visit we toured the building with the manager and noted the home is bright, airy, comfortable and spacious, with large communal areas and sufficient toilet and bathing facilities. Rakelands Nursing Home DS0000011536.V357025.R01.S.doc Version 5.2 Page 23 However, the size of the old three storey Victorian building means that it is difficult to provide the balance between being ‘homelike’ and meeting the nursing needs of those who live there, where for example commercial style laundry facilities are essential for the effective management of continence. A wide staircase and corridors and the provision of five shared rooms adds to a somewhat institutional feel. The manager said that a recent audit by a representative of the Company had identified single room accommodation as being an objective to be aimed at in the coming months. On a positive note in terms of present outcomes the manager said that those who currently share rooms generally benefit from the experience. All residents require support for all their personal care needs and specially equipped bath/shower rooms and toilets are located within easy reach of bedrooms and communal areas. People are encouraged to personalise their bedrooms and all the homes fixtures and fittings meet the needs of the individuals and can be changed if their needs change. All bedrooms are well decorated and personalised to reflect the individual tastes and personalities. The home provides a range of communal shared space. There are two large reasonably furnished comfortable lounges with dining areas. Both have been decorated to the specific tastes of those who use them. There is a large commercial style kitchen and adequate storage and office space for the effective running of the home. The home has plenty of lockable storage space and a staff accommodation on the second floor. Maintenance and redecoration are ongoing. Since the last inspection hallways, lounges, both offices, two bedrooms and all corridors have been redecorated. Cleanliness It was noted during the site visit that all areas of the home were clean, hygienic and free from unpleasant odours. There is a spacious laundry room fitted with commercial grade machines, enabling articles to be washed at appropriate temperatures. The home’s assessment indicates that all policies and procedures are in place for the control of infection and the safe disposal of clinical waste. Provider’s Annual Quality Assurance Assessment The assessment identified what the service does in this area: • Rakelands is an old three-storey, charming Victorian building, located in the scenic village of Rake. The home is designed to be, whenever DS0000011536.V357025.R01.S.doc Version 5.2 Page 24 Rakelands Nursing Home • • • • • possible, an environment that reflects domestic living arrangements. The service users have a safe and comfortable environment, which is well ventilated, free from industrial air odours and pollution. The service users have bedrooms containing their own chosen possessions. The furniture, fittings adaptations and equipment are of good quality and appropriate for the service user’s needs. Service users have easy access to a large well-kept garden, which has a Sensory section near the Day Centre. Within the grounds there is a Day Activities Centre comprising of a physiotherapy room, art room and cooking room. There is also a snoozeleen room and a Hydrotherapy pool to provide specialist physical and sensory support. Rakelands has 2 unmarked mini buses to facilitate outings, general appointments and travelling further afield. Accommodation is on the ground and first floor, and is connected by a lift and stairs. It is the objective of Rakelands that all service users enjoy a clean, smoke free environment, and the prevention of spread of infection. Rakelands Nursing Home DS0000011536.V357025.R01.S.doc Version 5.2 Page 25 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 - People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their manager. People are supported by an effective staff team who understand and do what is expected of them. EVIDENCE: Staff recruitment Individual staff recruitment files were available for inspection. An audit was carried out on a sample selection of two recruitment files, which were found to be in order. Two written references and Criminal Record and Protection of Vulnerable Adults (POVA) checks are carried out on all staff before they commence working in the home. Rakelands Nursing Home DS0000011536.V357025.R01.S.doc Version 5.2 Page 26 Staff training, development and competencies The home’s assessment confirmed that there is a staff development programme that meets National Minimum Standards for the service. During the site visit there was an opportunity to look at the computerised staff training plan. The manager said that staff training is regularly monitored by the Company training manager to ensure that all training needs are met. Records demonstrate that the full range of mandatory training is provided together with additional service specific training. The induction programme for new staff follows the Common Induction Standards required by ‘Skills for Care’. The manager said that the Company had recently implemented this induction programme and all new staff are now using the workbooks. New staff undertake a two week induction at the Company’s training centre before continuing the programme in the workplace. The manager confirmed and records showed that 86 of staff have achieved the National Vocational Qualifications (NVQ) at level 2 or above, or an equivalent qualification. The Company’s NVQ training programme ensures the standard of 50 qualified staff is maintained. Staff on duty spoken with said that the Company provides a good staff training package, which equips them well for the work they do. Provider’s Annual Quality Assurance Assessment The assessment identified what the service does in this area: • At Rakelands we have 24 hrs RN cover. Our team of qualified nursing staff provide nursing care to all service users. Each holds either a Learning Disability or Registered Nurse qualification. Some have specific areas of responsibility such as infection control, and health and safety representative. The manager, all registered nurses and senior support workers have attended a one day course in Supervisions and Appraisals. The manager is a Registered General Nurse with over 25 years experience in various specialties which include general nursing, care of adults with learning and physical disabilities and adults with mental health problem,s and care of the elderly. She holds an RMA qualification, moving and handling trainer’s course. 86 of staff have a qualification in NVQ 2,3 and an equivalent Naric conversion. All staff attend induction to gain knowledge of the disabilities and specific conditions of service users. All staff complete training in CWPLD within the first year of employment. All staff receive regular supervision and training to enhance their skills. DS0000011536.V357025.R01.S.doc Version 5.2 Page 27 • • • • • • Rakelands Nursing Home • • • • • • • Two written references are obtained for all staff and an enhanced CRB check prior to commencing work. All staff appointments are subject to a six monthly probationary period. All staff update with mandatory training, which is done annually. Robust recruitment procedures are in place with zero tolerance to agency staff. All new staff have attended induction training with Robinia. Staff receive regular supervision and an annual appraisal. 100 of staff have completed their probationary period satisfactorily. Rakelands Nursing Home DS0000011536.V357025.R01.S.doc Version 5.2 Page 28 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 - People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. EVIDENCE: Rakelands Nursing Home DS0000011536.V357025.R01.S.doc Version 5.2 Page 29 Management – The registered manager Mrs Virginia Tamba has been in post for about two years and is a qualified Registered General Nurse (RGN). She has achieved the Registered Managers Award (RMA). She states that she keeps up to date with regular mandatory and service specific training along with the other staff. All staff spoken with regarded the home as being well run, with regular staff meetings and formal supervision. They confirmed that the morale of staff was good and the manager was approachable and supportive. The manager completed their Annual Quality Assurance Assessment (AQAA), and returned it to us within the stipulated timescale. It provided sufficient information about how well Rakelands provides good outcomes for people who use the service. During the site visit we had an opportunity to observe in a general sense the way the home functions. It was clear from the interactions between the manager, staff and the residents that the manager is held in high regard. She showed kindness and understanding towards all the residents. Quality assurance – The Robinia Care Ltd website describes the Company’s quality monitoring system, which is based on seeking the views of those who use its services. Results of surveys are analysed and published. The manager gave examples and we saw some records of the home’s approach to quality assurance, which includes: • • • • • Yearly care reviews involving the social services care manager, the support worker, the resident and a relative. Regular auditing by the Company. Monthly statutory visits on behalf of the Company to monitor the conduct of the home. Regular staff meetings and formal supervision sessions. Written satisfaction surveys sent to families and a range of healthcare professionals. Rakelands Nursing Home DS0000011536.V357025.R01.S.doc Version 5.2 Page 30 Health and safety The home’s assessment confirmed that policies and procedures were in place to ensure safe working practices in the home. A sample of records was viewed including fire alarm tests and drills, public liability insurance, accident records and gas and electrical certificates, all of which were in good order. It was noted that accidents are carefully monitored and analysed by the manager and the home’s appointed health and safety rep’ to find out what can be done to minimise risks. Staff training records showed, and staff confirmed that statutory training is scheduled and updated in manual handling, first aid, fire training, infection control and food hygiene. Provider’s Annual Quality Assurance Assessment The assessment identified what the service does in this area: • The home is managed by a competent manager who is a Registered Nurse, moving and handling trainer and has also successfully attained a Registered Manager’s Award. There is a Service Development Plan and Operational Objectives in place, which are both reviewed annually. The manager ensures that service users’ views underpin all selfmonitoring, review and development by the home. She also ensures staff work in compliance with organisational policies and procedures, which are in line with the Valuing People legislation. The home ensures that the health, safety and welfare of service users are always promoted and protected. • • • Rakelands Nursing Home DS0000011536.V357025.R01.S.doc Version 5.2 Page 31 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 x 2 3 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 x 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 3 x LIFESTYLES Standard No Score 11 x 12 4 13 4 14 x 15 3 16 x 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 x 3 x x 3 x Rakelands Nursing Home DS0000011536.V357025.R01.S.doc Version 5.2 Page 32 Are there any outstanding requirements from the last inspection? No 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Rakelands Nursing Home DS0000011536.V357025.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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 Rakelands Nursing Home DS0000011536.V357025.R01.S.doc Version 5.2 Page 34 - 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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