Care Home: Ravenscroft

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What the care home does well Ravenscroft benefits from a well-maintained, attractive garden for people to enjoy. There are a range of different lounges and dining rooms, to enable people to choose where they can sit during the day if they wish to leave their room. The home has a core of staff who have worked in the home for many years and who are committed to supporting each other and the residents, for example covering for each other if someone is off sick. The home benefits from being part of a large care provider, who has established systems of working and who has developed policies and procedures to support staff in their roles. People commented on the home. One person described the "nice atmosphere", another that the home was "good with communication with regards to changes in policies, residents etc." and another person reported that they appreciated there being "no bad odours". People commented on the staff. One person reported "they`re pretty good down here", another "staff always got a smile and very sweet" and a visitor reported that they relative "speaks well of this place." A member of staff commented on the "good team work" another that the home "look after the staff and residents" and another "we give good quality care, within a very homely atmosphere, which we pride ourselves on". What has improved since the last inspection? The home have made major improvements in assessment of residents` needs and care plans. Where a person has a need or a risk, a care plan is put in place to direct staff on how needs are to be met and risks reduced. Where a person`s needs change, a reassessment is made. Care plans are up-dated when a person`s needs change. There is evidence that care plans have been consulted with the resident or their representative. Monitoring charts are completed at the time care is given and provide evidence that nursing and care is being given in accordance with care plans. Where a person has an established medical condition which can cause instability, the home ensures that residents are reviewed by relevant health care professionals. The clinical indicator for use of a urinary catheter is documented and body maps are used when a person has skin damage. Many improvements have been made in the management of medications. Registered nurses now comply with policies and procedures on the administration of medicines. Where people are prescribed medication on an "as required" basis, such as painkillers or aperients, protocols are in place to direct staff on when and why people are to be administered such medicines. The home generally follows national guidance when staff are administering insulin. Activities provision has been reviewed to develop systems that will meet individual residents` recreational needs. Systems for meals provision, have been reviewed to ensure that mealtimes are managed in an effective manner and that residents receive the supports that they need to eat their meals. The provider has made a review of the home environment and has developed an action plan to fully up-grade the home environment. At the time of the inspection, a new bedpan washer disinfector had been provided, some rooms had been up-graded, including re-carpeting and the communal rooms had been redecorated, with new arm chairs being provided. Profiling beds have been provided and old commode chairs replaced. What the care home could do better: The home needs to ensure that it has met all our requirements and good practice recommendations, or inform us about the situation if they are not able to do so. We were concerned that there continue to be five requirements which have not been met by their due date and the home have not notified us of why this is or when they plan to address them. There also continue to be four good practice recommendations which have not been addressed. The home needs to comply with our requirements in relation to accurate information for residents about the services provided by the home. This is to ensure that people have all the information that they need to make a decision about if the home can meet their needs. Pre-admission assessments need to be completed in full, signed and dated. This is to ensure that the home can demonstrate that it can meet residents` individual needs and to identify when the assessment was performed and by whom. Assessments need to document the importance of practice of religion to a person. Managers continue to need to ensure that staff follow care plans when providing nursing and care, so that residents have their assessed individual needs met. Care plans need to use measurable language and avoid the use of generalistic wording. Care plans relating to diabetes need improving. Residents` privacy and dignity would benefit from documenting how female residents with facial hair wish to be supported. Staff should always use residents own names when addressing them, not general terms of endearment such as "darling". When investigating complaints, investigations into the matters raised must be accurately completed. Senior staff should be aware of how to report allegations of abuse using the established procedures for doing so. Improvements are needed to ensure that principals of infection control are up-held. Staff must manage used laundry safely and there must be systems in place to prevent communal use of underclothing. Used laundry should be separated at source, not in the laundry. Hoists in communal bathrooms need to be clean and free of lime scale. Vacuum cleaner need disposable dust bags, so that they do not have to be emptied by hand. Some improvements are needed in equipment and staff performance. Wheelchairs must be safe to use and clean. Staff must follow the home`s policy on the use of hoist slings and not use them communally. Staff must also always perform safe manual handling to prevent risk of injury to residents or themselves. At various times of day, it appears that staff are not available to residents as they are busy with residents elsewhere in the home, so residents are left on their own. The provider needs to review staffing levels, communication system, staff allocations and other factors, to ensure that residents can always be supported when they need to be by a member of staff. Training needs to be developed, so that the home can demonstrate that staff have been trained to meet residents` different nursing and care needs, this should include catering staff. Key inspection report Care homes for older people Name: Address: Ravenscroft Hilperton Road Trowbridge Wiltshire BA14 7JQ     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Susie Stratton     Date: 0 6 0 5 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Older People Page 2 of 44 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 44 Information about the care home Name of care home: Address: Ravenscroft Hilperton Road Trowbridge Wiltshire BA14 7JQ 01225752087 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): ravenscroft@schealthcare.co.uk www.southerncrosshealthcare.co.uk Ashbourne (Eton) Limited Name of registered manager (if applicable) Ms Janet Margaret Rowland Type of registration: Number of places registered: care home 46 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability terminally ill Additional conditions: No more than 40 persons in receipt of nursing care at any one time. One named male service user under the age of 65 years can be accommodated. Room 27 is not registered for nursing care as overall ceiling height is too low. Date of last inspection Brief description of the care home Ravenscroft is registered to provide nursing and care for forty six older people. The home is an older building, which has been extended over the years, offering a range of single rooms and shared rooms over four floors in the newer part of the building and two floors in the older part of the building. Communal rooms are situated on the ground floor linked by a conservatory, which is also combined as part of the dining Care Homes for Older People Page 4 of 44 Over 65 45 0 0 0 1 3 Brief description of the care home room. There are gardens to the rear of the building and car parking at the front. Ravenscroft is situated on the outskirts of Trowbridge with good access to the town centre and its amenities. Southern Cross Healthcare owns the home. The registered managers post is currently vacant. A person is acting into this role. The fees range from 650 pounds to 800 pounds per week. Care Homes for Older People Page 5 of 44 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: one star adequate 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: As part of the inspection, 26 surveys were sent out and 14 were returned. Comments made by people in the surveys and to us during the inspection process have been included when drawing up the report. The homes file was reviewed and information obtained since the previous inspection considered. We performed a random inspection on 23rd November 2009, this was because of a range of matters brought up by external people. At that inspection, we identified a range of requirements and recommendations. An Annual Quality Assessment Audit (AQAA) was submitted to us to us before the inspection. An AQAA is the homes assessment of the quality of their service provision. It also provides numerical information on services provided. We looked at the surveys and reviewed all the other information that we have received about the home since the last inspection. This helped us to decide what areas we should focus on when doing the inspection. The site visit was performed by two inspectors, one of whom was a pharmacist Care Homes for Older People Page 6 of 44 inspector. These people are is referred to as we throughout the report, as the report is made on behalf of the Care Quality Commission (CQC). The site visit took place on Thursday 6th April May 2010, between 9:15am and 5:25pm. The visit was unannounced. The prospective manager was in charge of the home throughout the inspection. They and a senior manager from the provider were available for a brief feedback at the end of the inspection. During the site visit, we met with a range of residents in all parts of the home and also observed their care. We toured all of the home and observed care provided at different times of day and in different parts of the home. We reviewed care provision and documentation in detail for four residents, including three residents who had recently been admitted to the home and looked at specific records relating to a further two residents. As well as meeting with residents, we met with the deputy manager, a registered nurse, six carers, two domestics, the chef and the laundry person. We observed a lunchtime meal. We reviewed systems for storage of medicines and observed medicines administration rounds. A range of records were reviewed, including staff training records, staff employment records, complaints records, the statement of purpose and service users guide. Care Homes for Older People Page 7 of 44 What the care home does well: What has improved since the last inspection? The home have made major improvements in assessment of residents needs and care plans. Where a person has a need or a risk, a care plan is put in place to direct staff on how needs are to be met and risks reduced. Where a persons needs change, a reassessment is made. Care plans are up-dated when a persons needs change. There is evidence that care plans have been consulted with the resident or their representative. Monitoring charts are completed at the time care is given and provide evidence that nursing and care is being given in accordance with care plans. Where a person has an established medical condition which can cause instability, the home ensures that residents are reviewed by relevant health care professionals. The clinical indicator for use of a urinary catheter is documented and body maps are used when a person has skin damage. Many improvements have been made in the management of medications. Registered nurses now comply with policies and procedures on the administration of medicines. Where people are prescribed medication on an as required basis, such as painkillers or aperients, protocols are in place to direct staff on when and why people are to be administered such medicines. The home generally follows national guidance when staff are administering insulin. Activities provision has been reviewed to develop systems that will meet individual residents recreational needs. Systems for meals provision, have been reviewed to ensure that mealtimes are managed in an effective manner and that residents receive the supports that they need to eat their meals. The provider has made a review of the home environment and has developed an action plan to fully up-grade the home environment. At the time of the inspection, a new bedpan washer disinfector had been provided, some rooms had been up-graded, including re-carpeting and the communal rooms had been redecorated, with new arm chairs Care Homes for Older People Page 8 of 44 being provided. Profiling beds have been provided and old commode chairs replaced. What they could do better: The home needs to ensure that it has met all our requirements and good practice recommendations, or inform us about the situation if they are not able to do so. We were concerned that there continue to be five requirements which have not been met by their due date and the home have not notified us of why this is or when they plan to address them. There also continue to be four good practice recommendations which have not been addressed. The home needs to comply with our requirements in relation to accurate information for residents about the services provided by the home. This is to ensure that people have all the information that they need to make a decision about if the home can meet their needs. Pre-admission assessments need to be completed in full, signed and dated. This is to ensure that the home can demonstrate that it can meet residents individual needs and to identify when the assessment was performed and by whom. Assessments need to document the importance of practice of religion to a person. Managers continue to need to ensure that staff follow care plans when providing nursing and care, so that residents have their assessed individual needs met. Care plans need to use measurable language and avoid the use of generalistic wording. Care plans relating to diabetes need improving. Residents privacy and dignity would benefit from documenting how female residents with facial hair wish to be supported. Staff should always use residents own names when addressing them, not general terms of endearment such as darling. When investigating complaints, investigations into the matters raised must be accurately completed. Senior staff should be aware of how to report allegations of abuse using the established procedures for doing so. Improvements are needed to ensure that principals of infection control are up-held. Staff must manage used laundry safely and there must be systems in place to prevent communal use of underclothing. Used laundry should be separated at source, not in the laundry. Hoists in communal bathrooms need to be clean and free of lime scale. Vacuum cleaner need disposable dust bags, so that they do not have to be emptied by hand. Some improvements are needed in equipment and staff performance. Wheelchairs must be safe to use and clean. Staff must follow the homes policy on the use of hoist slings and not use them communally. Staff must also always perform safe manual handling to prevent risk of injury to residents or themselves. At various times of day, it appears that staff are not available to residents as they are busy with residents elsewhere in the home, so residents are left on their own. The provider needs to review staffing levels, communication system, staff allocations and other factors, to ensure that residents can always be supported when they need to be by a member of staff. Training needs to be developed, so that the home can demonstrate that staff have been trained to meet residents different nursing and care needs, this should include catering staff. Care Homes for Older People Page 9 of 44 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 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 10 of 44 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 11 of 44 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents will be supported by the homes pre-admission processes. They would receive additional benefit if some information were further developed and if all preadmission assessments were completed in full. Evidence: In their AQAA, it was reported that prospective residents are encouraged to visit the home so that they can decide if the home is suitable for them. They report that a complete information pack is provided either at enquiry stage or when the person visits the home. All prospective residents are assessed by a registered nurse, to ensure that the home can meet their needs. They report that they plan in future to make their information to be developed further for people with visual difficulties. People commented to us in surveys about information given to them by the home. Most people felt that they had been given enough information, however one person did not and another person did not know. We asked the home to provide us with Care Homes for Older People Page 12 of 44 Evidence: information as they might give any prospective resident and also to give us a copy of their service users guide. We looked at this information and noticed that it was attractively presented and provided prospective residents and their supporters with information about service provision. We observed that neither document had been updated with the current regulators details as was required at the previous key inspection. It also did not include information relating to previous inspections, as was also required so as to fully inform prospective residents of the homes response to inspections. These matters are un-met from the previous key inspection, over two years ago. The statement of purpose referred to a previous manager and administrator. The statement of purpose would also benefit from detailing how many staff are on duty at different times of the day and providing more detail on types of service provision, for example that the home provides terminal care and has facilities for very physically frail people, such as profiling beds and has bathing facilities to suit people with complex disability needs. We met with one person who had been recently admitted and a further two people who had been admitted recently. We observed that the home uses the providers standard admission assessment tool, which allows for a detailed pre-admission assessment to take place. We observed that two of the pre-admission assessments had been completed in detail, to provide evidence that the home could meet the persons individual needs, however one was not. This particularly related to the section on the form relating to dementia care needs. The resident did have additional dementia care needs, so it ought to have been completed, so that the home could demonstrate it could meet this persons needs. The home had also gained copies of information from the persons previous provider(s) to inform them of the persons needs. Two of the three admissions assessments had not been dated and signed. This is needed so that it can be clear that the assessment was performed prior to admission and by whom. One of the persons records showed that they belonged to a particular faith. Their records did not document the importance to them of their faith. As the person was unable to communicate, the assessment would have benefited from discussion with the persons family or previous provider about this. We met with these new residents. None of them were able to inform us about their admission. Records showed that one persons condition had improved considerably since they had been admitted, another person was beginning to show some slight improvement and a third had settled into life in the home. We discussed with staff how they found out about prospective residents needs. They reported that they were informed about new admissions at handover report and that they could also review the persons written pre-admission assessment records. The chef reported that they were always told about new admissions needs, for example any allergies and needs Care Homes for Older People Page 13 of 44 Evidence: for special diets, such as a diabetic diet. Care Homes for Older People Page 14 of 44 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. Residents nursing and care needs will largely be met, however a few issues remain relating to ensuring that full care plans are in place, that they are always followed by staff and in ensuring that all aspects of the residents needs for privacy and dignity are met. Evidence: In their AQAA, the home reported that residents and their families are involved in care planning, that care is evidence based and is clearly documented in individual care plans, that are reviewed regularly. They report they perform regular audits of care plans. People in the home also benefit from the input of external health care professionals and this is recorded in peoples care plans. They report that the home uses a monitored dosage system for medication and that their supplying pharmacist undertakes six monthly pharmacy reviews. They report that the provider is in the process of developing new formats for care planning and documentation, to support and enhance the care planning process. People responded to us in surveys about care and supports given to them by the Care Homes for Older People Page 15 of 44 Evidence: home. All apart from one person reported that they always or usually received the care and support that they needed. People also reported that they always or usually received the medical support that they needed. One person reported that the home looks after me well and another that the home gives quality care. All staff reported in surveys that they were always given up-to-date information about the people they cared for. One person reported we care very well for all our residents. During the inspection, we met with a range of residents and observed care provision at different times of day and in different parts of the home. We also discussed residents nursing and care needs with different members of staff. We observed that residents were assessed for risk or need, including pressure ulcer risk, risk of falls, dietary risk and manual handling needs. These risk assessments were regularly reviewed or when a persons condition changed. For example one person whose condition had improved since their admission had had all their assessments reviewed and up-dated to reflect their current needs. The home have put considerable effort into improving assessments and care plans since the last inspection. Where a person had a need or an assessment identified, a care plan was developed to direct staff on how to meet the persons needs. Care plans reviewed showed evidence that they had been consulted with the person. The home has a system for monthly reviews of care plans. There was also evidence of six monthly reviews of care plans with the resident and/or their supporters. Most care plans were clear and completed in detail. For example one person who had complex manual handling needs also took their continence needs into account, as this was relevant for the person. Another person had additional needs relating to dementia care and they had a care plan which directed how their dementia needs were to be met; this was written in non-judgemental language. Care plans relating to continence described the type of aid required to meet the persons needs. However some care plans needed development. One persons care plan stated that they were to have their position changed regularly as they were assessed as being at risk of pressure ulceration, without clearly stating how often their position was to be changed. Another persons care plan stated that they needed help with their personal care, without stating what sort of help they needed. Some care plans had not been completed in full. One persons care plan stated that their blood sugar levels were to range from......, but had then been left blank without stating the ranges for the person. One persons care plan stated that they had a skin condition and they had a range of different prescribed preparations in their room, but their care plan did not state which preparations were to be used for them, when and on what part of their body. Another person had had their painkillers increased by their GP, a record of this Care Homes for Older People Page 16 of 44 Evidence: was made in a part of their care plan, but not the part which related to their medical condition and there were no references to the persons experience of pain in their daily records to provide evidence of monitoring of this need for the person. We considered that as care plans as this were an area which needed much development at the random inspection, the fact that some matters had not been addressed in full, while they still need addressing, is of less concern than it might otherwise have been. Where a person had a wound, the home ensured that their condition was monitored by the tissue viability nurse. There were clear records relating to the persons wound, including photographs. All care plans reflected in full the tissue viability nurses advice. Where a resident had a urinary catheter in place, there were clear records relating to the care and management of the persons catheter, including the clinical indicator for the use of the catheter. Peoples records showed evidence of regular consultation with their GPs when needed. A registered nurse described the local GPs as supportive Staff informed us that they were regularly up-dated about how to meet residents different and changing needs in both handover reports and in care plans. Carers completed records of the care that they had provided. Records were properly completed, for example all fluid charts were totalled every 24 hours. We observed that the deputy manager quickly noticed that a resident looked uncomfortable and took prompt action to make the person more comfortable. We made observations of if care was provided in accordance with care plans. One persons care plan described how they needed their meals to be pureed. We observed at lunch-time that all their meals were pureed. Another persons care plan stated that they were to be supported in settling in by the provision of items from their own home. We observed that their room had been made a homely as possible for them. However, as at the last inspection, we observed that staff continue not always to provide care as directed in care plans. One persons care plan stated that a particular type of sling was to be used for them when assisting them to transfer using a hoist. We observed that the person was assisted to move using a different type of sling from that directed in their care plan. People need to be moved using the correct sling for them, otherwise they could be put at risk. We also observed that a persons care plan stated that they were to use a particular type of cutlery for their meals, we observed that they were using the homes own cutlery as lunchtime. Another persons care plan stated they were to use a particular skin preparation. There was none visible in their room. All personal care was given behind closed doors. Where staff were transferring a person using a fully body sling, they ensured that the persons lower body was always Care Homes for Older People Page 17 of 44 Evidence: covered by a blanket. One resident was clearly nervous when placed in the hoist, staff were observed to be very supportive to this person throughout the time that they were in the hoist sling and after the person was placed in an armchair. We observed that one resident had a very clear care plan relating to their preference for sex of carer to give them personal care. However two female residents were seen to have issues relating to facial hair. As at the last inspection, their care plans continued to not document how the persons needs in this respect were to be met. As at the last inspection, we observed carers not calling people by their own preferred name but using general terms of endearment, such as darling and my lovely. Residents needs to be addressed by their own or preferred name; this is particularly the case for people with dementia care needs. We met with a resident who had additional dementia care needs and while they could converse for short periods of time, were unable to remember their own name, so use of their own name would have been particularly important to them. Our Pharmacist Inspector looked at medicine handling in the home. The medicine storage in the home was secure and suitable, however the cupboards that held the controlled drugs did not comply with current legislation and so did not provide the additional security needed for these medicines. We looked at the medicine administration records for people in the home. They were clear and provided the information needed to give people their medicines safely. Separate records were kept with these of the use and effects of medicines that were sedating and these were reviewed monthly. One record for an anti-coagulant medicine could not be evidenced against the original prescription. Staff told us how that particular surgery had had problems with some records recently and we saw another anti-coagulant record that was correctly recorded. We checked one persons record which showed when the doctor had stopped a medicine and this was clearly recorded on the administration record. We looked at the records for people receiving insulin. The injection sites were recorded and correctly rotated and we saw evidence of the involvement of the community diabetic team. One person was prescribed insulin in a form that is specifically used for people with sight or dexterity problems to administer to themselves, however this person could no longer manage this and the nurses were administering it. The use of this device was, therefore, unnecessary and could cause confusion. We saw the nurses give out the medicines at lunchtime in a caring manner using a safe method. Creams that had been applied by carers during the morning were signed for by the nurses during this round. This does not accurately reflect what has been done as, if the carers are delegated this responsibility, they should be recording that it is done at the time. The manager told us that the company is bringing in new paperwork to make these records easier to use. Records were seen of medicines received into the home and those sent for disposal which meant that the Care Homes for Older People Page 18 of 44 Evidence: medicines could all be accounted for. Care Homes for Older People Page 19 of 44 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. Residents will have some of their needs for recreational activities, choice and meals met but will benefit more when designated people are in post to provide activities, records relating to this are further developed and more staff being available to support residents before mealtimes. Evidence: In their AQAA, the home reported on their extensive range of activities from one to ones to outings. They also reported on their extensive range of food choices and flexibility for catering staff to provide meals as required. They stated there were regular visits by the local church and religious orders to support service users beliefs, including monthly Holy Communion. There were two hairdressers who came to the home each week and appointments could be booked as required. They reported that the Friends of Ravenscroft, volunteers and staff fund-raise for activities and social events, with regular volunteers entertaining the residents and give examples of hand bell ringing, singing and karaoke. They reported that in the past twelve months, they had improved the lounges, providing flat screen televisions and fish tanks. They had purchased two pet guinea pigs to provide enjoyment and therapy for the residents. During the next year, they planned to create a seating area at the front of the home with raised beds to improve access to plants for residents in wheelchairs, improve Care Homes for Older People Page 20 of 44 Evidence: access to the back garden and extend the patio area in the back garden to enable easy access for wheelchairs. People gave a mixed reaction to the provision of activities by the home in surveys, with two people reporting that the home always, three usually, one sometimes and one never provided activities which they could take part in. One person reported I enjoy the entertainments we have and another the home has improved, new furniture & new tv, the activity team seem to go down well. A visitor we met with reported that they felt their relative needed more stimulation and another that residents need to go out more. We have been made aware that the activities coordinators are no longer in post. We are also aware that there has been a range of opinions expressed about this matter. People we met with during the inspection were aware of the situation. One person commented that residents were sitting in chairs now, no stimulation and another that residents did not get anything in relation to activities. We observed that a temporary activities plan had been drawn up and was displayed on notice boards. On the day of the inspection, there was Holy Communion in the morning. A Bingo session also took place in the afternoon and we observed a carer performing manicures for residents on a one to one basis during the afternoon. The prospective manager reported that carers were working additional hours in the afternoon to provide activities and they were also planning to lead some activities until people were in post to lead activities. We visited the lounges often during the morning and observed that residents were largely left unsupported, apart from when staff were performing such roles as giving out drinks or bringing residents into the lounge. We discussed this with the deputy manager who reported that a carer was always allocated to the lounge but that they could be called away to assist others and that they were trying to change the culture to support staff in understanding that supporting residents in the lounges was a key area in meeting residents needs. We looked at records relating to activities. The prospective manager reported that they were in the process of developing these. The provider had a tick sheet relating to activities participated in by residents and these were being introduced. They were also planning to develop individual folders relating to the resident, their past live, interests and hobbies. These could then be developed into an individual profile and be the basis for care plans about how the person was to be stimulated. They would also include records relating to the benefit of different activities for residents. To date only three of these had been developed. When these are developed for all individuals, this will be a Care Homes for Older People Page 21 of 44 Evidence: good basis for supporting residents in their recreational and stimulation needs. Residents reported that they could get up and go to bed when they wanted. They also reported that their visitors could come and go as they wished. One resident reported to us that they were an early riser and that that the lady comes and tells you when to get up. Another person had a detailed night care plan about when they preferred to get up and go to bed. A member of staff reported to us that between ten and eleven residents did not wish to go to bed early, remaining in the lounge after 8:00pm. A relative reported on how they appreciated being able to support their relative in arranging their room and bringing items of their own into the room. A relative reported that when their relative fell, that the staff informed them promptly; this was echoed by another relative. People commented on the meals in surveys. Four people reported they usually and three sometimes liked the meals. A resident said to us after lunch that they had liked part of the meal. A visitor reported to us that their relative always seems happy with the food. We observed a resident who had clearly enjoyed the lunch, so much so that they licked the plate after they had finished their meal. All the staff we spoke with knew what supports residents needed at mealtimes. We observed a lunchtime meal and noted that it was much more organised than at the previous inspection, with residents being served table by table and staff being available to support residents whose attention wandered, to ensure that they did not forget to eat or their meal become cold. When residents could not give themselves their meal, staff were available to support them. We observed that one resident was complex to support at the mealtime and that the member of staff assisting them supported them throughout, although it took an extended period of time for the person to eat their meal, due to their complex needs. We observed a carer informing a resident who needed assistance about what part of the meal they were giving to them as they assisted them to eat. We observed that, while it was advertised in the dining room that lunch was from 12:30 to 1:30, that it did not commence at 12:50, when trays were taken to residents who were eating their meals in their own rooms. Some residents had been placed in the dining room from 11:50 but the first meal was served in the dining room at 13:05, so people would have been sitting in the dining room waiting for lunch for and hour and a quarter before the meal was served. One resident showed clear signs of being distressed by sitting at the table for such an extended period. We asked the chef and other staff if our observation of lunch being served after 12:30 was an unusual observation. They reported that the times lunches were served varied, depending on Care Homes for Older People Page 22 of 44 Evidence: resident need for support by staff, but that the observation on the day of the inspection was not unusual. We thought that if more staff were available in the late morning, meals could be served more promptly and residents not need to wait so long for their meal. Where residents ate their meals in their own rooms. They were taken meals on a tray. They were given both their main course and dessert at the same time. Good practice recommendations advise that people should be given courses separately. This is because hot desserts can become cold and cold desserts hot, and so become unappetising. Residents who need support with taking in an adequate diet may also not eat their first course if they are given their dessert at the same time. We met with the chef, who was enthusiastic in their role. They showed a good individual knowledge of residents and their needs. They reported that they met with each resident every day and found out about their meals preference at that time. They also reported that they kept a close eye on the slop bucket to review returned meals. They reported that they used full cream milk and cream to support residents with weight loss. They made soups and sauces from raw ingredients, reducing risks associated with packet preparations. They were able to make cooked breakfasts for residents who wanted them. They had some knowledge of diets for elderly people such as diabetes, risk of weight loss and dementia, but would benefit from more training in this area to further develop their role. Care Homes for Older People Page 23 of 44 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents will largely be supported by the homes complaints and safeguarding procedures, however they would be further supported by more development in some areas. Evidence: In their AQAA the home reported Manager operates an open door policy to ensure stakeholders are able to discuss concerns when needed. They reported that all complaints were recorded and dealt with promptly as per the providers policy. They reported that as well as the complaints policy being clearly displayed in the foyer, feedback cards were also available. The manager maintains a grumble book to track trends in minor complaints which do not come under the formal complaints policy. Most people reported in surveys that they knew how to raise issues informally and were aware of the homes complaints procedure, however one person reported that they were not aware of how to do this. All staff reported that they knew what to do if a person had concerns about the home. People commented to us about raising matters of concern during the inspection. One person reported that if they were not happy about something too true I tell them and that the home always accept it beautifully. Two visitors reported that they could always approach the deputy manager, one reporting that the deputy manager was lovely, sorts out problems. The deputy manager reported that they encouraged families to come and talk to them at any time and people did this. However two people we spoke with reported that they Care Homes for Older People Page 24 of 44 Evidence: found the prospective manager not approachable. We reviewed the managers complaints records and observed that they appeared to be acted upon and investigated in accordance with company policy. We also reviewed their concerns records, which they called their grumble book and observed that a range of matters were documented there. We observed that staff wrote in residents records where people had raised issues of concern. The prospective manager reported that they were confident that all such matters would be reported to them. We had received a complaint from a person who wished to remain anonymous about the condition of the homes wheelchairs, since the random inspection. In one part of the managers response, they stated wheelchairs are checked by the maintenance man on a monthly basis and this is documented. If there are any faults, these are addressed immediately, to ensure the safety and well being of residents. This statement is not factually accurate. During the inspection, as detailed in Environment below, we observed a range of wheelchairs where their condition needed attention, to ensure that they were in a good condition and safe to use. Where matters are sent to the home for investigation, we anticipate that a full investigation will take place and an accurate statement about their findings be drawn up. Since she came in post, the new manager has ensured that all staff have been trained in safeguarding. We spoke to staff, including a carer and a domestic, both of whom were fully aware of their responsibilities for reporting suspicions of abuse to the manager. A range of safeguarding referrals have been made about this home during the past year. Some have been investigated by the Wiltshire multi-agency team and some referred back to the provider for investigation which the provider has done. The most recent allegation was not referred via Wiltshire Social Services as is required, although it was reported to us. The new manager may need further training in the Wiltshire procedures, to ensure that referrals are made to the correct agency. Local procedures need to be followed to ensure that all relevant authorities are aware of allegations and agreed procedures followed, to ensure the safety of people. Care Homes for Older People Page 25 of 44 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. The home environment continues to need improvement, residents will be supported as the providers action plan is developed. Risks to residents in relation to practice on infection control and certain equipment have not yet been fully reduced. Evidence: In their AAA, the home reported that Ravenscroft has a homely atmosphere that enables stakeholders to feel relaxed and comfortable. During the past twelve months, they have stopped using double rooms for unrelated residents, re-decorated the lounges, including purchase of new armchairs and flat screen TVs, several bedrooms have been re-carpeted and that there is a rolling programme of room re-decoration, including purchase of new bedroom furniture and continued upgrade of beds to profiling style. In addition new commodes have been provided throughout the home and new over bed tables provided for use in rooms and lounges. People commented to us on the home environment. One person reported my [relative] seems pleased in [their] new bedroom and has has a new tv & bed and bedside cabinet, however another person reported the company could do with more refurbishments in the home. This was echoed by staff. One person reported that the home could do refurbishing better, another that the home could have more work done on the redecorating side to make the home more homely, another that the owners needed to refurbish the home - staff room, nurses station, having an area Care Homes for Older People Page 26 of 44 Evidence: where its more private for doctors etc to talk about residents, concerns etc as the nurses station is to open and another that they were hoping their will be enough good wheelchair. Staff reported on how supportive the maintenance man was and that they were on call throughout the 24 hour period and available to support them when needed. We toured the home and observed that while action had been taken to make improvements, particularly in the lounges and some bedrooms, other areas continued to need attention. This included corridor areas where sections of un-painted walls and scrapes were visible, sluice rooms where many had walls which were not intact and could not be wiped down and kitchenettes where surfaces were old and stained and shelving showed chipping. We discussed this with the prospective manager, who was able to show us a full and detailed action plan, which had been costed by the provider to make improvements to the home environment across a range of areas. We observed that a new sluice room had been provided on the first floor of the older part of the building. Profling beds had been provided for residents since the last inspection and the prospective manager reported that more such beds were on order. We observed that two integral bath hoists continued, as at the previous random inspection, to show yellowing deposits of lime scale on the back and under-surface. If bath hoists are not clean, as well as not respecting a persons dignity, there is a risk to cross infection. We observed that all bathrooms had hoist slings, which were numbered, hanging from pegs. The deputy manager reported that they now nearly had enough slings for each resident to be allocated their own slings. They also reported that the procedure was for hoist slings to be laundered after use. We observed that staff were not consistently following the homes procedure. In a sitting room we observed that there were two green hoist slings, one marked 11 and the other 15. These slings were observed to be used for all residents who needed to be transferred from a wheelchair to an arm chair throughout the inspection, including a person whose care plan stated that they had been assessed as needing a blue sling. People need to be moved using the sling which they have been assessed as needing, otherwise it can put them at risk. Staff need to follow company policy on the use of hoist slings to prevent risk of cross infection and up-hold residents dignity. We observed that residents were brought to the sitting room in wheelchairs by staff. The quality of wheelchairs varied. Some were new, however several were not. We observed several wheelchairs which had lost one of both or their back slings on the foot pedals, this could put people at risk of their feet coming backwards off the pedals. One foot-plate has lost its surface with the original adhesive showing underneath. One wheelchair was observed to have no tread left on their wheels. Some wheelchairs Care Homes for Older People Page 27 of 44 Evidence: were not clean, showing debris on their chassis. The maintenance man was reported to check the wheelchairs every month. There was no evidence that they had received formal training in this. As noted in Complaints and Protection above, we had received a complaint about the condition of the wheelchairs, so it is of surprise that these wheelchairs had not been taken out of commission or mended by the inspection. We met with several of the domestics. One of them showed us their cleaning trolley and the different coloured clothes and mop heads which they used for different areas, to ensure that the principals of infection control were up-held. They reported that they had a good supply of cleaning chemicals. They also reported that staff were very good at informing them of when a resident had an infection. We met with another domestic who was outside, emptying out the contents of a vacuum cleaner sack into a black bag, by hand. They were not wearing gloves and dust was visible on their trouser legs. We asked them why they were doing this, they reported that a newly purchased vacuum cleaner did not have a disposable sack provided, so they had to empty the cloth bag every two to three days in this manner, when the bag became full. Such practice in a care home with nursing is not safe and vacuum cleaner bags need to be fully disposable to prevent risks to cross infection. We met with the laundress and looked at the laundry. They reported that they vacuumed behind the machines every day. We observed that the detergent dispensers were placed on cardboard, with deposits visible on the cardboard. The laundress explained that they placed cardboard under the dispensers because of the way they had to fill the dispensers. All areas in a laundry need to be wipable. Management needs to identify how detergent dispensers can be safely filled without using a material underneath them which cannot be wiped down. The laundress reported that all infected and potentially infected laundry came down to the laundry in red alginate bags. They reported that all staff fully complied with company policy when managing infected and potentially infected laundry. All other laundry continues to be placed together in a linen bag and has to be re-sorted in the laundry. This is not regarded as good practice and all used linen should be separated at source to prevent risks to cross infection. We observed that one linen skip had lost its wheel and so could not be moved with ease. We also observed a member of staff moving a bag of used linen by dragging it along the corridor by its neck. Cloth laundry bags should not be moved in such a manner as this presents a risk to cross infection. We observed three tubs of unmarked clothes on a trolley in the laundry. One tub contained ladies pop socks, another dark coloured male socks and the other underwear. We asked the laundress why this was. They replied that they were aware Care Homes for Older People Page 28 of 44 Evidence: that the manager was planning to introduce washable bags, for small items such as underclothes and socks. These bags would be marked with the residents name or room number, to prevent the communal use of such items. Communal use of such items, as well as not up-holding a persons dignity is a risk to cross infection. We had identified this matter as a requirement at the previous inspection with a compliance date of 2nd February 2010. The home has not compiled with this requirement within timescales or notified us of the situation either in their AAA or other correspondence. Care Homes for Older People Page 29 of 44 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. Residents will be supported by some of the systems to ensure safe recruitment, training and numbers of staff, however this is an area for further development, to ensure that residents are fully supported. Evidence: In their AQAA, the home reported that every resident had a named nurse and key worker, photos of these are displayed in each bedroom. They reported that off duty rotas were prepared at least four weeks in advance and that there were systems to present the home from being short of staff and potentially leaving the residents at risk. There was a structured induction programme in line with the providers policy and procedure. All staff had contracts, job descriptions and staff handbooks and that staff personnel files were well maintained. They reported that the provider supported staff to undertake National Vocational Qualifications (NVQ) and other training. They reported that during the past twelve months they had provided regular staff training to ensure staff have the knowledge and skills to undertake their roles. People commented about staffing in surveys. Five people reported that staff were usually and two sometimes available when they needed them. Five members of staff reported that there were always, four usually and one sometimes enough staff to meet the individual needs of people. Two people commented on the friendly staff and another that the home did training sessions well. People commented to us about Care Homes for Older People Page 30 of 44 Evidence: staffing during the inspection. One person reported if you ring the bell, they come, another most staff approachable and another some of the staff are very nice. However one person reported staffing a bit short and another that they did not know how to get help if they needed it. Staff reported that the home did not use agency carers but that they did need to use agency registered nurses at times. As documented earlier in the report, we observed that a member of staff was not consistently with residents in the sitting room throughout the morning. This was of concern as we observed one resident repeatedly try to raise themselves from their chair. This person had a history of falls. Other residents were frail and would have needed observation to ensure that they received the supports that they needed as they could not communicate with ease. As also noted elsewhere in the report, lunch was served to people in the dining room at five minutes past one, although some people had been placed in the dining room at ten to midday. It was reported that this related to staffing levels and the numbers of staff needed to meet the individual needs of residents during the late morning. The off-duty showed and staff confirmed that there were seven people on duty - two registered nurses and five carers - during the afternoon period. Ravenscroft is a complex building, with four floors in the newer part of the building and two floors, which are not fully interconnected, in the older part of the building. Many residents needed two people for personal care. This meant that two people could be busy in one part of the building and two in another, without staff quickly knowing where people were in the building if they needed assistance. As is also stated elsewhere in the report, between ten and eleven residents were reported to choose to remain up in the evening until after 8:00pm, which is when day shifts finish their duties. At night, from 8:00pm until 8:00am, there are four members of staff on duty. This means that there would be four members of staff to assist people, some of whom may have complex needs, to bed. Which again means that during this period staff may not be available to assist residents in the sitting room, this is particularly as registered nurses will need to be performing a medicines round and other clinical duties during this period. For all these reasons, we consider that there is a potential for risk to residents, which the home needs to review, to ensure that it has the policies and procedures in place to ensure that sufficient staff are on duty who are able to communicate with each other, to ensure that individual residents needs can be met and their safety maintained. During the inspection we reviewed files relating to four members of staff. We observed that three of them included all required information relating to the persons past working history, two satisfactory references, police checks, proof of identify and health checks. However one person who had been recruited centrally by the head office, while they had a work history, proof of identity and health questionnaire, only had one Care Homes for Older People Page 31 of 44 Evidence: directly sourced reference on file and did not have a proof that they were able to work in this country. At the time of the inspection, there appeared to be no evidence of police checks on their file, but the manager was able to provide subsequent evidence that such checks, directly sourced references and proof that they were able to work in this country, which had been held central office, were now available in the home. All people recruited by the home had had an interview assessment performed. We discussed supports to newly employed staff, including induction. The deputy manager was able to describe to us how they supported new staff. The providers induction format conformed in full to guidelines. The deputy manager reported that all new carers work supernumerary and that they allocated each new member of staff to a senior person to act as their mentor. Records of inductions were maintained. These were signed off to show that the person has been inducted in each area. We asked about inductions for agency staff. The home were not using such inductions. A senior manager was able to provide the home with the providers standard agency induction form during the inspection and the new manager reported that they would use it from then on. The homes AQAA indicated that they did not have 50 of care staff trained to NVQ two or above. We discussed this during the inspection and the manager was able to provide us with evidence of the numbers of carers who were working towards this award. This would still not enable the home to meet the target of 50 care staff trained to NVQ two or above. The manager reported that they were planning to support newer carers in working towards NVQ qualifications, once they had been in post for a longer period. Since they have been in post, the new manager has put much effort into ensuring that mandatory training is in place for all staff. They have introduced a training matrix so that they can see at a glance who is due for training and in which areas. They were aware of a few gaps for individuals in mandatory training and were aware of the reasons for this and action(s) to be taken to ensure that these members of staff did receive training. Staff reported to us on supports for staff training and about the courses they had undertaken since the new manager came in post. We asked staff about training in areas relating to resident care. Some people reported that they had had dementia training and others diabetes, but that had been a few years ago. It was reported that the home also asks visiting professionals, such as the tissue viability nurse to provide supports when they visit. As the home cares for people with a range of care needs such as continence, visual, auditory, diabetic and dementia care ends, they need to perform a training plan to identify what training Care Homes for Older People Page 32 of 44 Evidence: needs to be in place to enable staff to fully support residents, so as to ensure that their individual needs can be met. Care Homes for Older People Page 33 of 44 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. Residents will be supported by management systems and their health and safety largely met, a few areas need to be addressed, but this is likely to relate to an extended period in the recent past, where the home did not effective management systems in post. Evidence: In their AQAA, the home reported that the provider has excellent computer systems that enable management and administration to be undertaken in a timely manner. They reported that there was a clear audit trail for all aspects of administration from management of residents finances to management of staff annual leave allocation. They reported that the manager had been in post since September 2009 and was in the process of registering with CQC as manager. This person was reported to have extensive experience as a nurse manager in both the NHS and private sector. In addition to being a Registered Nurse, the manager was also reported to hold a Diploma in Nursing and be a qualified moving and handling and First Aid instructor. Care Homes for Older People Page 34 of 44 Evidence: Prior to the new managers appointment, the home had been without a registered manager for a period of time. Due to this, a range of matters had needed action, including care planning, management of medication, staff training and development and staff supervision and support. This inspection showed evidence that the new manager had been able to take action across a wide range of areas to address such issues, including some matters identified in the random inspection. Some areas have not been addressed and these are identified in this report. Considering the range of areas which needed to be addressed it is not surprising that not all matters had been addressed in full by this inspection. However we anticipate that where matters have not been addressed in full, we need to be advised of this either in the AQAA or by other means, to ensure that we are appraised of the situation. The provider was advised of the need to inform us of progress towards meeting our requirements in their annual service review of 21st October 2009, where we stated neither the previous years AQAA nor the current AQAA commented specifically on progress towards meeting some of the requirements and recommendations from the previous inspection and we advise that the home should always do this, to provide evidence that they have met, or on how they are working towards meeting matters required or recommended by us. The provider has systems for regular audit of stakeholders views and if matters are identified puts action plans into place. The provider performs monthly visits to the service and writes a report into their findings. The new administrator has fully reviewed procedures for residents moneys and valuables and modernised the systems, which are now fully auditable. As noted in staffing above, the new manager has ensured that training has been developed in mandatory areas. At the last inspection, we observed some unsafe manual handling. At this inspection, we also observed such practice. On three occasions, we observed a carer manoeuvring a wheelchair by lifting it up so that the rear wheels were off the floor and pivoting the wheelchair on the small wheels at the front of the chair. This is unsafe practice as the resident could be put at risk of coming out of the chair and it also has the potential to injure the member of staffs back. We also observed two members of staff support a resident by lifting them under their arm-pits, without using a lifting belt. This is also unsafe practice. The manager reported that they were aware that safe manual handling was an area which would need to be supported for a period of time, using a combination of training, observation and supervision, to ensure that staff were fully aware of the risks of unsafe practice. The home has systems to ensure that the home is fully maintained. They also perform required checks, including fire safety checks and checks on bath water temperatures. Care Homes for Older People Page 35 of 44 Evidence: Where a resident needed oxygen, correct warning signage was in place. Where residents were assessed as needing bed-rails, the homes assessments were completed in full and conformed to directions from the Health and Safety Executive. Care Homes for Older People Page 36 of 44 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 1 4(1) 5(1) The registered person must ensure that the homes statement of purpose and service user guide be updated in relation to: the regulators contact details Information regarding previous inspections. This is to fully inform people of the services provided by the home. 01/02/2010 2 7 12(1)(a) Management must ensure 01/02/2010 that staff always follow care plans when providing nursing and care. Care plans direct how peoples nursing and care needs are to be met. If staff are not following care plans, the home cannot ensure that the resident is receiving the care that they need. 3 26 13(3) Staff must manage used laundry safely and systems must be developed to prevent communal use of residents underclothes and socks. This is to prevent risks to cross infection and up-hold residents privacy and 01/02/2010 Care Homes for Older People Page 37 of 44 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 dignity. 4 26 13(3) Hoists in communal bathrooms must be clean and free of lime scale. This is to prevent risks of cross infection and also to up-hold residents privacy and dignity. 31/12/2009 5 38 13(5) Staff must always perform safe manual handling. This is to ensure the safety of residents and staff. 01/02/2010 Care Homes for Older People Page 38 of 44 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 3 14 All pre-admission 30/06/2010 assessments must be signed, dated and completed in full. This is so that the home can identify when a preadmission assessment was performed and by whom. If a person is known to have a need the home must make their own assessment to show that they can meet the persons needs. 2 9 13 Clear records must be made 01/07/2010 at the time of administration of all medicines, including creams and lotions. This is so that an accurate record is made of all medicine administrations. 3 9 13 Controlled drugs must be stored in a cupboard that complies with the Misuse of Drugsand Misuse of Drugs (Safe Custody) Regulations. 01/08/2010 Care Homes for Older People Page 39 of 44 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 This is so that all medicines are stored safely and in accordance with the law. 4 16 22 All complaints must always be fully investigated. This is to ensure that all matters which may affect residents are fully considered. 5 18 13 The home manager and other senior staff must familiarise themselves with the local safeguarding procedures. This is to ensure that people follow agreed procedures which have been put in place to ensure that allegations of abuse are correctly investigated. 6 22 13 All wheelchairs must be clean, in a good condition and be safe for use. This is to ensure the safety of residents who need to use wheelchairs. 7 26 13 Vacuum cleaners must always have fully disposable sacks and staff must always use gloves when handling vacuum cleaner sacks. 31/05/2010 31/05/2010 30/06/2010 31/05/2010 Care Homes for Older People Page 40 of 44 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 This is to prevent risks of cross infection. 8 26 13 All staff must always follow company policy on the use of hoist slings. This is to prevent risks of infection, ensure safe manual handling practice and up-hold residents dignity. 9 27 18 A full written review of 30/06/2010 staffing levels must be performed throughout the 24 hour period, to ensure that residents who remain in the communal rooms are fully protected, to ensure communication between staff is possible when there are fewer staff on duty and to ensure that individual needs can be met, particularly at lunch time and the late evening. This is to ensure the safety of residents and that their individual needs can be met. 10 30 18 The home must develop a training plan which considers residents nursing and care needs and to identify how staff are to be trained to meet such residents needs. 30/06/2010 31/05/2010 Care Homes for Older People Page 41 of 44 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 This is to ensure that residents individual needs can be met. 11 33 26 Where we have set a 30/06/2010 requirement, we must be informed if the home are not able to meet the requirement by the required date, the reasons why and actions being taken to ensure compliance. This is to ensure the health, safety and welfare of people. 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 1 1 The homes statement of purpose should provide more information on the types of residents cared for and how they can meet their needs. They should also give information on how many staff are aimed for on each shift. Pre-admission assessments should ascertain the importance to a person of the practice of their faith, where relevant. Care plans should include clear and measurable language. Care plans relating to diabetes should always state actions staff need to taken when a persons blood sugar levels fall outside their documented parameters for blood sugar levels. This recommendation was identified at the random inspection of 23/11/09. It has not been addressed. 2 3 3 4 7 8 5 10 Where female residents show facial hair, care plans should Care Homes for Older People Page 42 of 44 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 document how they are to be supported in maintaining their self-esteem. This recommendation was identified at the random inspection of 23/11/09. It has not been addressed 6 10 Staff should not use generic terms of endearment when addressing residents. This recommendation was identified at the random inspection of 23/11/09. It has not been addressed 7 8 15 15 Where residents eat meals in their rooms, their first course and dessert should be served separately. Catering staff should be supported in undertaking training relating to conditions associated with older persons nursing and care needs. Used laundry should be separated at source, not in the laundry. This recommendation was identified at the random inspection of 23/11/09. It has not been addressed. 9 26 Care Homes for Older People Page 43 of 44 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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