Care Home: Rheola

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What the care home does well The home has lots of information about admission and support for families considering making any arrangements with the home. The home has immediately and appropriately reported any concerns that they have been aware of. Staff are polite and respectful towards people and are helpful when asked. The service continues to have a high turnover of people living at the home because they provide short-term respite care arrangements and short-term Interim care placements. What has improved since the last inspection? The nine requirements made in the last inspection report have been met. The home has lots of information about admission and support for families considering making any arrangements with the home. The home was fresher and brighter.The two activities workers plan activities so that all people living at the home are included. A new manager has become registered since the last inspection. As a consequence the regular supervision of staff occurs. What the care home could do better: The progress and recovery of people who are living at the home temporarily under `intermediate`, or `interim` care arrangements made as part of the hospital discharge planning should be better informed, so there is an accurate record of the persons assessed needs, their changing needs and an evaluation of their anticipated progress within the appropriate care plan. Further promotion of safeguarding vulnerable adults would help to assure people and staff and visitors what to do, should they want to independently report abuse. People were observed to spend long periods alone. It was noticed that staff are not often prepared to spend time with people or to engage with them This was noticed on the two ground floor suites of Rose and Thistle, as well as on the upper floors were it was difficult to find care assistants. Staff could spend more time with people and be engaging in meaningful and ordinary ways. The building is large and there are areas of the home that are not within the vision of care staff and an arrangement should be considered to help staff be sure they are not missing any incident or event. The home carried out a customer satisfaction survey earlier this year that contained several comments that the home was short staffed. There were also positive comments that the home is run well and that staff and management are helpful. CARE HOMES FOR OLDER PEOPLE Rheola Broad Leas St Ives Cambridgeshire PE27 5PU Lead Inspector Don Traylen Unannounced Inspection 22nd August 2008 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Rheola DS0000015108.V370792.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Rheola DS0000015108.V370792.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Rheola Address Broad Leas St Ives Cambridgeshire PE27 5PU Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01480 375163 01480 375160 caroline.goddard@excelcareholdings.com Rheola Healthcare Ltd Mrs Caroline Jayne Goddard Care Home 42 Category(ies) of Dementia - over 65 years of age (13), Old age, registration, with number not falling within any other category (32) of places Rheola DS0000015108.V370792.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 22nd August 2007 Brief Description of the Service: Rheola is a care home registered to provide for a total of 42 elderly people including 13 people with Dementia related care needs. Originally a Local Authority care home it was acquired by Excelcare Holdings in 2001. The home is situated a few minutes walk from St Ives town centre. It is a large house that has been converted to a care home and has had an extension added to the rear of the building. There are well kept gardens to the rear and side of the property. The home is divided into four units Rose and Thistle suites are located on the ground floor and Shamrock and Daffodil are on the upper floor. Each suite has a separate dining room, lounge, kitchen, toilets and bathroom. Rose suite is a single storey extension that provides accommodation for 10 people who have care needs associated with dementia. Thistle and Shamrock suite each have 12 bedrooms whilst Daffodil suite has 8 bedrooms. Each bedroom has a washbasin. Twelve rooms have full en-suite facilities. The home has a contractual agreement with Cambridgeshire Primary Care Trust to provide 5 respite care places and to provide up to 3 Interim Care places. Fees range from £351 to £500 per week. Inspection reports about the home are available in the entrance lobby of the home and can be accessed on the CSCI website Rheola DS0000015108.V370792.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is “ 2 star”. This means the people who use this service experience good quality outcomes This inspection was carried out when the manager was present. The home completed an Annual Quality Assurance Assessment (AQAA) and 12 of the 20 comment sheets/surveys sent were returned from people using the service. The admission process and care planning was assessed, a tour of the home was conducted and observation were made of the interaction with care assistants and people living at the home. What the service does well: What has improved since the last inspection? The nine requirements made in the last inspection report have been met. The home has lots of information about admission and support for families considering making any arrangements with the home. The home was fresher and brighter. Rheola DS0000015108.V370792.R01.S.doc Version 5.2 Page 6 The two activities workers plan activities so that all people living at the home are included. A new manager has become registered since the last inspection. As a consequence the regular supervision of staff occurs. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Rheola DS0000015108.V370792.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Rheola DS0000015108.V370792.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,6, Quality in this outcome area is good. People are assured their admission is prepared and the home knows their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: One person who recently moved into the home wrote in their survey that s/he was invited to visit before deciding to move in. All people are assessed for their needs either by a Primary Care Trust (PCT) Care Manager, or Social Worker, or by the home if people are independently funding their care. The assessment detail and arrangements for people admitted for intermediate, or interim care was not sufficient for the home to plan care or for the person’s rehabilitation to be evaluated. This was discussed with one visiting relative and with the manager during the inspection. Rheola DS0000015108.V370792.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,910, Quality in this outcome area is good. People’s care plans suitably set out their care and their health needs are assured by community health services. This judgement has been made using available evidence including a visit to this service. EVIDENCE: District Nurses visit and attend to some people’s needs. A record of the visits are kept by the District nurse but are not recorded in the person’s care plan. There were some areas of uncertainty about any information or messages regarding community health service support that are not recorded by the home. This was discussed in depth with the team leader and the manager at the time. Two care plans for people living in Rose suite showed that there are good daily records maintained and the plans are adequate. One person’s care plan stated to brush teeth X 2 daily but it was not monitored or known if this oral care plan Rheola DS0000015108.V370792.R01.S.doc Version 5.2 Page 10 was being provided. There was guidance about mental capacity related to dementia needs and good pressure sore prevention for one person. One other person’s care plan showed her admitted for ‘respite’ care when this was intermediate care requested by the hospital. Her daughter in law had not seen her care plan despite being expected to provide some of her care when she would return home. Her daughter-in-law was unaware of her progress and timing she was likely to return home. The attendance and input of community nurses or physiotherapist were not recorded in the plan and this uncoordinated approach had not informed the home of how they should monitor and assess the person for her rehabilitation. One person’s written comment was that the care and support was, “way above my expectations”. His relative also added that he is informed, “if anything needs to be changed” and that, “ideas (are) exchanged to see the best way forward for my father’s needs”. The home has rewritten a suitable policy for the safe administration of medication that includes instructions for ‘as required’, or ‘PRN’ medication. Medication was observed being given in Rose suite and was checked for accuracy of record keeping and was considered to be safely managed and administered. Rheola DS0000015108.V370792.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15, Quality in this outcome area is good. People are reasonably assured of an anticipated lifestyle within the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People were observed to spend long periods of being alone. Some of this may be choice and because of certain disabilities. For people living in Rose suite, where their needs are associated with Dementia, it was observed between 10:30 and 11:30 am that there was little, if any staff interaction with people. It has a compact and small communal living/dining room and a long corridor to individual rooms. Eight people were seated in this room without any noise, or music or physical activity. The day was warm and sunny and the door to the enclosed paved garden area was open. Nobody was outside or ventured outside. One care worker spent most of this time in the small kitchen and not with people. The other care assistant did talk to some people but this was limited and very brief. However, the interaction that did take place was meaningful and focussed and was respectfully conducted. Rheola DS0000015108.V370792.R01.S.doc Version 5.2 Page 12 There are two activities worker providing 21 hours of activities each week. There were activities observed in the Shamrock lounge attended by eleven people who were enjoying a musical making session with various level of participation being kept. The atmosphere was friendly and was a focused action that some people participated in by intently watching. People were encouraged in a positive yet respectful manner to participate. One person spoken to in Daffodil suite stated that he did not have enough activities or interests that he could follow. He was realistic that his condition greatly reduced his ambitions. However, the two activities workers plan activities so that all people living at the home are included. Some of their activities are spending time with some people who would not otherwise have much company. One person’s written comment was that she participates in “several activities” and these included “bingo and quizzes also dancing when mobility allows”. Another person wrote, ”the entertainment is good most of the time”. One person who smoked wrote that the home should have a smoking room. This facility is not provided and causes one person difficulties of where to go to smoke. Another person wrote that s/he wanted more outdoor activities. The home has a notice board showing photographs of people enjoying activities. There are frequent family visitors to the home. A few people take themselves out of the home whenever they wish. Three people have electric scooters to use outside of the home. There were many comments that the food was good. There were some comments that at teatime there were too many sandwiches and not a regular alternative. Rheola DS0000015108.V370792.R01.S.doc Version 5.2 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18, Quality in this outcome area is good. People are assured the home will protect them. This judgement has been made using available evidence including a visit to this service. EVIDENCE: One person wrote that he did not know how to complain and that this needed explaining. The home does have a complaints policy, keeps a record of complaints and has a procedure that is written in their Statement of Purpose and is available within the home in written form. The home has a suitable adult protection/safeguarding policy with reporting procedures and has the guidance issued by Cambridgeshire County Council. Whilst there was a leaflet by the entrance areas there was not other available information for people, visitors, or staff, of where any suspicion or allegation of harm could be reported, how this would be dealt with. Some more independent people stated they were not aware of where they could independently report abuse, should they ever need or want to. Staff had been trained in safeguarding. Rheola DS0000015108.V370792.R01.S.doc Version 5.2 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,26, Quality in this outcome area is good. People are assured the home’s environment is generally safe and clean and is well maintained. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Overall the home was clean and bright, well ventilated and was free of any offensive odour. All hazardous substances and areas were kept locked. There were no signs indicating a possible spread of infection, other than that referred to below. New carpets have been laid in Rose suite and new washable flooring has been ordered for one room. The garden area at the rear of the home had been improved and was an attractive flower area that was a safe enclosed area for people to enjoy although nobody was seen to be using it. In the separate garden/paved area Rheola DS0000015108.V370792.R01.S.doc Version 5.2 Page 15 for people living in Rose suite the wastewater piped from the laundry room into an outside covered drain was overflowing. The fluid had run off into a central drain in the middle of the paved garden area. This represented a real risk for any person to slip on, as well as the potential for infection. This was pointed out to the manager who said that she would ask the maintenance department to deal with this immediately. A Requirement was made at the last inspection for people to have easy access to suitable and safe external areas and this has been provided, apart from this unsafe nature of the garden/outside paved area for Rose suite. Some of the dining chairs in the dining room in Thistle suite were sticky with spilled fluids, or drinks. We asked a care assistant to clean two of these chairs when we were speaking to a group of relatives who were visiting. The door locks for one of the toilets and one of the bathrooms in Thistle suite were not able to\ be lacked easily and these do not guarantee a person dignity. Rheola DS0000015108.V370792.R01.S.doc Version 5.2 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30, Quality in this outcome area is adequate. People are not assured of sufficient staff to meet their needs at all times. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staff reported that more dementia training is wanted. One care worker stated that working with new staff on limited staffing levels is a problem. On the day of inspection there were two care staff working across Shamrock and Daffodil units on the upper floor where there were nineteen people living. The area is large and has long corridors. This was an issue for two care staff to oversee, one of whom was a very recently employed and inexperienced care assistant. It is considered that the home are using minimum numbers of staff when only two people are responsible for this upper floor area. On the afternoon of the inspection the more senior carer on this upper floor was expected to administer medication. The induction arrangements were not structure around Skills for Care Council’s standards for induction and were not assessed for these core standards. However, the home did have an induction programme but it was not sufficiently developed to guarantee staff would receive a full and competency Rheola DS0000015108.V370792.R01.S.doc Version 5.2 Page 17 assessed induction that could be included on the Skill for Care National Minimum Dataset. The home’s training matrix was brief and undeveloped and did not include a planned future training. A competence trainer did not carry some of the training provided by the home out. Competent key trainers in Adult protection, Moving and Handling skills and Medication Administration are necessary for the home to provide appropriate Induction and ongoing training for staff. The records showed that staff who were trained in 2005 needed refresher training in adult protection. Recruitment records for two care workers showed that the home should be more rigorous about obtaining two suitable references when they have recorded references addressed to ‘whom it may concern’, or references provided by employees of the home who have known the applicant previously. Full details including employment start dates were not available in staff files. Rheola DS0000015108.V370792.R01.S.doc Version 5.2 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38, Quality in this outcome area is good. People are assured a competent manager promotes their best interests. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection a new manager has been registered. She has endeavoured to improve training to more staff although there are further improvements still to be made in this matter. Supervision is a regular feature of support for staff. She has led by example and this has been reflected in service users comments about her effort and the confidence they have in her. Rheola DS0000015108.V370792.R01.S.doc Version 5.2 Page 19 The home carried out a customer satisfaction survey earlier this year that contained several comments that the home was short staffed. There were also positive comments that the home is run well and that staff and management helpful. This report has highlighted that staff do not sufficiently engage with people. The building and the numbers of staff combine to have this effect. One person stated that he felt vulnerable because of the absence of staff and that people do enter the building unchallenged. There is no evidence to suggest that staff are missing events, or people’s needs and there are no negative outcomes reported in this inspection because of this. However, it was noticed that staff were difficult to locate throughout the inspection, especially on the upper floor. It is anticipated that these management issues will be addressed. Health and safety is promoted. Fire alarm system certificates are in place and the emergency lighting is certificated. Fire drill and fire equipment is regularly testing and recorded. Thermostats control all hot water. An Environmental Health Officer assessed the kitchens again in January 2008 and the home had responded to the requirements made in that report. Rheola DS0000015108.V370792.R01.S.doc Version 5.2 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 2 2 X X X X 3 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X N/A X X 3 Rheola DS0000015108.V370792.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP21 Regulation 23(2)(C) Requirement Timescale for action 01/10/08 2 OP26 23(2)(O) 3 OP30 18(1)(C) The locks on toilet doors and bathroom doors must be maintained in good working order so that people are assured of privacy and their dignity is not compromised. The outside drain in the Rose 01/10/08 suite garden/paved area must be made safe so that people are not at risk of slipping and are free from any risk of cross infection. The home must provide a 01/10/08 structured induction so that people are assured they will be cared for by competent and trained care workers. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations Care plans for people admitted for intermediate care should record their progress or otherwise and should DS0000015108.V370792.R01.S.doc Version 5.2 Page 22 Rheola contain an aim or gaol for their rehabilitation. 2. OP12 It is recommended that as an activity of daily living, the home take measures to encourage care staff to adopt a more definite approach to include people in ordinary everyday activity. Contact telephone number for reporting abuse should be made available throughout the home so that any person living at the home, or visitor, or family, have this same opportunity and protection and are enabled to report any concern about abuse they may have. The home should consider increasing staffing numbers so there are more than two people working on the upper floor. 3. OP18 4. OP27 Rheola DS0000015108.V370792.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Rheola DS0000015108.V370792.R01.S.doc Version 5.2 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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