Care Home: Rangemore Nursing Home

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What the care home does well Each person who comes to live at Rangemore is assessed so that they know their needs can be met. All the people who live at Rangemore have an individual care plan in place so that staff know what they need to do for each person. There is enough staff on each shift so that people living in the home are not rushed and their independence is maintained. Medicines are managed well so that people receive their medicines as prescribed. The food on offer is good and wholesome and people spoken with said " the food is good" A good standard of hygiene was seen throughout the home. All staff receive regular training to improve their skills. What has improved since the last inspection? Some areas of the home have been redecorated and new furniture has been purchased. The care plans are now on a computorised system and are more person centred. What the care home could do better: The activities on offer need to improve so that people have enough to do and can make choices about their day so that they have some control over their lifestyle. A summary of complaints needs to be put in to place so that a clear audit trail can easily be followed. The number of staff with an NVQ level two training needs to be improved so that people are cared for by staff who have had have had formal training to carry out their roles. Recruitment procedures need to improve so that people who are employed at the home are safe to work with elderly people. A quality assurrance system should be put in to place designed to identify strengths and areas of improvements. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Rangemore Nursing Home Chester Road Bucklow Hill Knutsford Cheshire WA16 6RR     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Joan Adam     Date: 2 3 0 7 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 22 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 22 Information about the care home Name of care home: Address: Rangemore Nursing Home Chester Road Bucklow Hill Knutsford Cheshire WA16 6RR 01565830396 01565830667 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mr Richard Dickinson care home 49 Number of places (if applicable): Under 65 Over 65 0 25 dementia old age, not falling within any other category Additional conditions: 24 0 The registered person may provide the following categories of service only. Care home with Nursing - code N to people of the following gender:- Either. Whose primary care needs on admission to the home are within the following categories: - Old age not falling within any other category - Code OP, (maximum number of places: 25) Dementia - Code DE (maximum number of places: 24) The maximum number of people who can be accommodated is: 49 Date of last inspection Brief description of the care home Rangemore Nursing Home is situated in the Cheshire countryside, close to the towns of Lymm, Knutsford and Altrincham. There are 2 lounges, three seperate dining rooms and a lounge/dining room. Bedroom accommodation is provided on two floors with access between floors by passenger lift and stairways. The home provides nursing care for 49 older people, including people with a dementia related illness, accommodated within their own wing. The current charges for the home are #550 to #630 per week. This information has Care Homes for Older People Page 4 of 22 Brief description of the care home been provided by the home manager. Care Homes for Older People Page 5 of 22 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We made an unannounced visit to Rangemore on 23 July 2009. This was to assess if peoples needs were being met at the home. During the visit we spoke to the manager at the home, some staff members and some residents. Some of the comments we received is detailed in this report. Before the visit the home was asked to complete an annual quality assurance assessment (AQAA) to provide up to date information about services of the home. Other information since the last key inspection was also reviewed. Feedback was given to the home manager at the time of the visit. Care Homes for Older People Page 6 of 22 Care Homes for Older People Page 7 of 22 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 22 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 22 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: 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 and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this 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 are fully assessed before they live at Rangemore Nursing Home so they know their needs can be met. Evidence: We looked at the AQAA and this told us that each person and their family is given information regarding the home before they are admitted. When we visited the home we found this to be true. The care plans for two newly admitted people were looked at. These contained detailed pre-admission documents which had been fully completed by senior staff before the person had been admitted to the home. Details from the hospital and social services were also present. This information was used to write a plan of care to let staff know what their needs were and how they could meet them. Care Homes for Older People Page 10 of 22 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this 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 who live at Rangemore Nursing Home have their health,personal and social needs met in a dignified way. Evidence: We looked at the AQAA. This informed us that each person who lives in the home should have a comprehensive care plan in place. When we visited we found this to true. Care plans were looked at for people living at the home on both units and it was found that people receive care in the way that they choose, that each person has a plan of care, which gives staff clear instructions on how to provide care in a way which people preferred. Care plans are on a computerised system and staff spoken with said it is a comprehensive system which is user friendly. A moving and handling assessment had been completed on each resident so that staff would know how to move them safely. A nutritional assessment had been filled in so that staff would know if the residents were at risk of loosing weight. Monthly weights were recorded.Choices were recorded such as when they liked to get up, where they spent their day and how their spiritual needs were met. Visits from other health care Care Homes for Older People Page 11 of 22 Evidence: professionals such as G.Ps and district nurses were recorded so staff would know when these visits had taken place and why. The reviews were detailed as were the daily records so staff would know what changes, if any, had been made. The computor system had an audit system in place so that staff were remined of when the review date was due. Staff, when observed, treated people with respect and spoke to them in a kind and caring way.Information from staff said that they feel they give good care. People who live at the home looked well cared for but when spoken with were unable to express an opinion due to their frail or confused state. Medicines on both the units are managed well. The home uses a blister pack system for medication so that staff can see which medicines have been given out each day but some bottle and boxed medicines were used. These had all been recorded as to the amount delivered to the home so that staff were aware of how many medicines were in the home at any one time. All medication administration sheets had been completed. Controlled drugs were checked and the checking of these by staff had been recorded appropriately. Items with a short shelf life in the drug fridge had been dated and signed so that staff would know when these had been opened. Care Homes for Older People Page 12 of 22 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: 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 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. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at Rangemore Nursing home are able to take part in limited activities and mealtimes were a positive experience. Evidence: The AQAA tells us that the home does not have an activities co-ordinator employed at the present time. Staff are providing activities on an ad-hoc basis during the afternoon when they have more time to spend with the people who live at the home. Staff spoken with confirmed that they talk to people, read them newspapers and sometimes play with the soft ball or do board games. On the day of the visit no activities were taking place as the GP was present in the home and the hairdresser was attending to peoples hair. Staff spoke with people when they were performing tasks such as taking them to the toilet or through to the dining room for meals. When observed speaking to people they appeared kind and caring. The food on offer looked well presented and appetising and people who live at the home appeared to be enjoying their lunch. People who needed assisted with their meal were treated with patience and dignity by staff. Care Homes for Older People Page 13 of 22 Care Homes for Older People Page 14 of 22 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this 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 who live at Rangemore are confident that their complaints are listened to and staff have received training so that they know what to do to protect people. Evidence: The AQAA states that the home has had two complaints since the last visit. The home does not have a complaints log, however, the complaint and the action taken had been recorded. A further complaint had been made verbally to the manager and this had not been recorded. Complaints should be clearly logged so that an audit trail can easily be followed. The home has had one safeguarding issue and this has been dealt with appropriately. policies and procedures are in place and the home is aware of Cheshire No secrets policy. All new staff have received safeguarding training from Macclesfield college. All other staff have had some training and an update is to be arranged in August 2009. Care Homes for Older People Page 15 of 22 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some areas of the home need to improve to make it a comfortable place to live and visit. Evidence: We walked round the home and looked in all communal areas, bathrooms and some bedrooms. The home was cleaned to a good standard and there were no unpleasant odours. Some bedrooms in the home look shabby and in need of redecoration. Some furniture is worn and needs to be replaced. The tiles were coming off the wall in one shower room. We saw that some bedrooms had been decorated and bedroom and lounge furniture had been replaced and the manager said that this was an on going programme. The shower chair in the West Wing needs to be replaced with a more stable chair to avoid accidents. Care Homes for Older People Page 16 of 22 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent 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 to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Recruitment procedures need to improve so that people who live at the home are kept safe. Evidence: We found that staff are supplied in sufficient numbers to meet peoples needs and people who work in the home said they thought that there was enough staff on duty on each shift. We saw that a few of the staff working in the home have achieved a national vocational qualification in care. Some staff that had gained the qualification whilst working at the home have left. Five staff are currently undertaking NVQ level two and six staff are undertaking NVQ level three. This qualification shows that staff have had formal training to carry out their roles. We saw staff training is on-going and that all staff have received mandatory training in key subjects. This means that staff have been given the skills to promote peoples health and welfare. We looked at three staff files and two of these had the appropriate checks carried out before staff commenced work so that the home was sure that people are safe to work with elderly people. However, one staff member only had one written reference in place before they commenced work at the home. Care Homes for Older People Page 17 of 22 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some areas of management need to improve to ensure that the home is well run. Evidence: The manager has been in post since February 2008 and has been registered with CQC( formally CSCI) and has attained NVQ level 4 in management. She has experience in the caring sector and has worked at Rangemore for many years. She is supported by two unit managers who are qualified nurses. The home does not have formal meetings with residents and relatives but the manager speaks to people who live at the home daily and to their families when they come to visit. Staff meetings are not held but communication with staff is on going at daily hand overs . Notices containing information are also posted in the staff room. Surveys received by staff stated that they felt the manager communicated with them well and on a regular basis.Regular staff training sessions regarding fire safety are held to make sure staff know what to do in case of fire and there was a record of the names of staff Care Homes for Older People Page 18 of 22 Evidence: attending. The AQAA gave us details of when equipment in the home had been checked and serviced to make sure that it continues to be safe and effective. Small amounts of residents monies are held and all transactions are recorded so people who live at the home know their money is safe. A summary of complaints at the home should be recorded so that an audit trail can be easily followed. The recruitment system needs to improve so that all staff employed have the correct safety checks in place before they commence work at the home to enable the manager to know if they are safe to work with elderly people. A full detailed quality assurance system should be put in to place designed to identify strengths and areas of improvements. Some audit checks are completed on hot water temperatures in bedrooms and bathrooms. Care Homes for Older People Page 19 of 22 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 20 of 22 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 12 16 Activities on offer must be improved. So that people are stimulated and do not get bored. 21/08/2009 2 16 22 A summary of all complaints 28/08/2009 must be clearly recorded or logged. So that a clear audit trail can be easily followed. 3 33 24 A detailed quality assurance system must be in place. To identify areas of weakness so actions can be taken quickly. 31/10/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 21 of 22 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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