Care Home: Ringshill Nursing Home

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What the care home does well There is a good standard of information to assist the person in their decision where to live. We were told that the staff are `Very good`. Another person said that they `Liked living here; there is no hassle`. People have opportunities to live a generally good life. People are listened to and there are systems in place to reduce the risk of abuse against any of the residents. People live in a clean and generally comfortable place. People can be confident that they are cared for by generally competent staff. People benefit from a generally well-managed service. What has improved since the last inspection? Since our random inspection and receiving the AQAA in January 2009 there has been a reduction in the number of residents who have acquired a pressure sore whilst living at the home. There have been safety rails put in place for when the people enter and leave the inner courtyard. There has been an introduction of a `lunch box` for people to have for supper time, or later, and there has been a successful introduction of a `Breakfast Club`. In November 2008 the home received, from the local authority, a four star award for food hygiene. What the care home could do better: The standard of the pre-admission information received into the home could be better. The home is making arrangements to address this issue. Care plans must be drawn up in consultation with the resident where possible and actively reviewed at least once a month. Care plans should be more person centred. We have made no requirement or recommendation about care plans as we expect the home to take action. Where a person has been assessed to need mouth care we expect this care to be provided.We have made no requirement, on this occasion, as we expect the home to take action. We have made two requirements and one recommendation about medication records and the administration of medication. A requirement about `when required` medication has not been met, from the last key inspection, and this has been carried forward with a new timescale. We have made a requirement about the information obtained about staff during the recruitment stages. Fire alarms must be tested in accordance with the home`s policy. We have made no requirement, on this occasion, as we expect the home to take action. Substances that are a risk to people`s health must be stored in a safe manner when left unattended.We have made no requirement, on this occasion, as we expect the home to take action. Key inspection report Care homes for older people Name: Address: Ringshill Nursing Home Sallowbush Road Huntingdon Cambridgeshire PE29 7AE     The quality rating for this care home is:   two star good 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: Elaine Boismier     Date: 2 1 0 4 2 0 0 9 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 29 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) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Ringshill Nursing Home Sallowbush Road Huntingdon Cambridgeshire PE29 7AE 01480411762 01480450940 ringshill@fshc.co.uk www.fshc.co.uk Ringdane Limited (wholly owned subsidiary of Four Seasons Health Care Limited) care home 87 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: No more than 61 nursing care beds Date of last inspection Brief description of the care home Our last key unannounced inspection was carried out on the 8th April 2008 and a random unannounced inspection was carried out on the 29th August 2008.Ringshill Nursing Home is on the edge of a large housing estate on the outskirts of Huntingdon and is registered to provide care, including nursing care, and support to people over the age of 65 years. There is a local bus service serving the area. It is a short walk from a general store and within easy driving distance of the town of Huntingdon. The accommodation is on two floors with the upper floor being served by two lifts. Fees currently range from £358 to £613 per week depending on the needs of the person. Additional costs include hairdressing, toiletries, private chiropody and newspapers. Further information about fees can be obtained from the home. A copy of the Care Homes for Older People Page 4 of 29 Over 65 9 87 0 0 Brief description of the care home inspection report is available, on request at the home, or via the CQC website at www.cqc.org.uk Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We, The Care Quality Commission (CQC), carried out this key unannounced inspection, by two Inspectors, between 9:50 and 15:25, taking approximately 5.5 hours to complete. After the last key unannounced inspection of the 8th April 2008, we carried out a random unannounced inspection, in August 2008, during which we found that people were receiving the right care and treatment for their nutrition and for their skin. We found there was some deficiency in the way one of the people was sitting that posed a risk in them developing a pressure sore. We made no requirements following this inspection as we expected the home to take action to reduce such a risk. Before this inspection we carried out an annual service review (ASR) on the 6th March 2009. The ASR was a review of the information we had received from and about the home, since our last key inspection that we carried out on the 8th April 2008. We had Care Homes for Older People Page 6 of 29 received eight surveys from residents and a survey from a member of the staff. We also received a completed Annual Quality Assurance Assessment (AQAA) that was completed by the Manager. Following our ASR we considered to bring this key unannounced inspection forward, before the scheduled date of April 2010. During this inspection, of 21st April 2009, we case tracked three of the residents in that we spoke with them, or their visitor, visited their rooms and compared our findings with their care records. We also spoke with the staff, including the Manager, looked around the premises and examined some of the records. We also spoke with and watched other residents who were not part of our case tracking. For the purpose of this inspection report the people who live at the home are referred to as person, people, resident or residents Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? What they could do better: The standard of the pre-admission information received into the home could be better. The home is making arrangements to address this issue. Care plans must be drawn up in consultation with the resident where possible and actively reviewed at least once a month. Care plans should be more person centred. We have made no requirement or recommendation about care plans as we expect the home to take action. Where a person has been assessed to need mouth care we expect this care to be provided.We have made no requirement, on this occasion, as we expect the home to take action. We have made two requirements and one recommendation about medication records and the administration of medication. A requirement about when required medication has not been met, from the last key inspection, and this has been carried forward with a new timescale. Care Homes for Older People Page 8 of 29 We have made a requirement about the information obtained about staff during the recruitment stages. Fire alarms must be tested in accordance with the homes policy. We have made no requirement, on this occasion, as we expect the home to take action. Substances that are a risk to peoples health must be stored in a safe manner when left unattended.We have made no requirement, on this occasion, as we expect the home to take action. 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 9 of 29 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 10 of 29 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. There is a good standard of information to assist the person in their decision where to live although the pre-admission process poses some risk to the standard of care provided to the people who move in. Evidence: All of the eight residents surveys said that they had enough information, about the home, to help them in their decision where to live. On entry to the home there is information about the home, including the star rating awarded after the former inspection unit, The Commission for Social Care Inspection (CSCI), had inspected the home, in April 2008. The people we spoke with, as part of our case tracking, said that they, or their relative, had information about the home, including a brochure, before the person moved in. There was insufficient pre-admission information provided to the home before a person moved in and, as a result of this, this led to a complaint which was part of the Care Homes for Older People Page 11 of 29 Evidence: discussion at a safeguarding meeting held on the 13th March 2009. We considered that the home had a duty to ensure that it was satisfied with the information provided by referring agencies, before accepting the person. We looked at three peoples care records and we found that there was information about the persons assessed needs and the home had received this information before the person had moved in. We also looked at a pre-admission assessment of a person who was due to be admitted to the home later that day and we also spoke with a member of the staff who was examining this information. Evidence indicated that there was a lack of detail as, for example, the person was assessed to have memory difficulties although this did not say how it affected the person. The member of the staff stated that there was not sufficient detail about the person but said that once the person arrived, the home would assess the persons needs more thoroughly. The Manager reported that a new complaint was possibly due to the current standard of pre-admission information. She stated that arrangements were in place to improve the standard of pre-admission information received. Care Homes for Older People Page 12 of 29 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. There is some risk to the health and welfare of some of the residents. Evidence: As part of our case tracking we spoke with two of the residents and we spoke with a relative of the third resident and we looked at these three peoples care records. Evidence indicated that the care plans provided information and guidance in how to meet the needs of the people and risk assessments were referred to within the relevant care plans. For example where a person was assessed as being at risk of developing pressure sores the care plan referred to this risk assessment and what care was to be provided to reduce this identified risk.We expected the home to improve the standard of care planning, to include when a person was provided, or declined the offer, of when they had their personal care. We found records in one of the peoples care plan that stated when the person declined having a bath. Although the AQAA noted that the people were consulted when their care plans were being drawn up we found, however, from talking with the people, that they had no knowledge about their care plan records and we found no evidence recorded that the Care Homes for Older People Page 13 of 29 Evidence: person, or their relative, had been actively consulted about their care plans. We noted that there were some deficiencies in the care plan records. For example it was unclear how a person, who had been assessed as being at a high risk of falls, could walk or move around as the care plan stated the person walked with or without aids. The Manager stated that this was the case as it depended on the time of the day although the care plan lacked such detail. There were short term care plans for the development of conditions such as a chest infection.The majority of the care plans had been actively reviewed each month although a care plan, developed in January 2009, had not since been reviewed and it was unclear if the person should be receiving the recommended treatment for their swallowing difficulties, from the speech and language therapist. For a person with a medical condition there was clear guidance for the staff in how to meet the physical needs of the person although this failed to be person centred i.e. there was no evidence to say how the person felt about their condition and what difficulties they personally experienced, if any. We have made no requirement about care plans as we expect the home to take action in the areas that need to be improved upon. We carried out a random inspection, on the 29th August 2008, and no requirements were made. We found people were receiving the right nutritional care and the right care and treatment, with the exception of one of the people who was sitting in a way that caused their clothing to become restrictive and therefore increasing the persons risk for developing pressure sores. A strategy meeting, held in November 2008, showed that a person had unnecessarily acquired a pressure sore The AQAA notes that, within the last 12 months 4 people have acquired a pressure sore. According to the Manager there is currently one person who has acquired a pressure sore whilst living at the home. All of the eight residents surveys said that the person was satisfied with the support, care, including medical care, provided to them. A visitor told us that they were very satisfied with the standard of care provided to their relative, It is very good we were told. Another person said that they Liked living here; there is no hassle. We saw people receiving treatments and assessments by visiting opticians, district nurses and a chiropodist. The three peoples care records indicated that they had received assessments and treatments from health care professionals such as the speech and language therapist, general practitioners, hospital dentistry services and a Parkinsons disease nurse specialist. Care Homes for Older People Page 14 of 29 Evidence: One of the people we case tracked we noted that the person was assessed as having a dry mouth and the care plan provided details of what specific care the person needed to overcome this dryness. We spoke with the person, in their room and evidence indicated that the person was not provided with this prescribed care. They told us that their mouth was dry, that they did not have mouth washes or similar mouth care and we found no specific equipment to provide this care. (The person also told us their food was tasteless which might have been due to their dry mouth). We expect the home to manage this issue rather than we make a requirement on this occasion. Medicines prescribed for people are kept securely under controlled temperature conditions.This ensure peoples medication is of good quality.Temperatures of the medicines storage areas are recorded although the temperature of the fridge used for medicines on the ground floor had been recorded outside the recommended range for a long time without action being taken to ensure the residents were receiving effective medicines.We expect this to be managed by the home rather than make a requirement on this occasion.We looked at the records of medicines received into the home, disposed of and when they are given to people.When we checked the quantity of medication that should be left against these records we found a number of discrepancies.We saw that one person who should have had medication twice a day was only given it once a day for three days until it was noticed.This could have resulted in the person suffering harm and it was not reported to either the home manager, the persons GP or to the Commission.Where people regularly refuse their medication, it is not being reported to the persons GP and the reason for refusal is not recorded.We have made a requirement about the need to give medication to people as prescribed and for the records made to be accurate.Some people are prescribed medication on a when required basis, but there is not always clear guidance for their use.This could result in people receiving too much or too little medication and the requirement made previously has not been met.The response from the provider that this requirement had been met is not substantiated and it has been rolled forward with a new timescale for action. We watched medicines being given to some people at lunchtime and this was done professionally with regard to peoples dignity and personal choice. We saw the staff knock on peoples doors before entering and we saw that the staff interacted with the people in a kind and caring way. A visitor told us that the staff were Very good.One of the residents surveys said that Some times I dont like the night staff although the person did not tell us why. Care Homes for Older People Page 15 of 29 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have opportunities to live a generally good life. Evidence: All of the eight residents surveys said that the person was satisfied with the range of activities provided by the home. We saw some of the people taking part in an exercise game and those people we spoke with, as part of our case tracking, said that they chose not to take part in the activities as they preferred their own company, watching television and solving word puzzles. These choices and preferences were recorded in these peoples care plans. We saw some of the people receiving guests and a visitor told us that they could visit the home any time. The people we spoke with also said that they received guests and the visitors signing in book indicated that there is no restriction to visiting. Peoples rooms were personlaised with pictures, ornaments and photographs. Six of the eight surveys, from residents, said that they liked their meals although the remaining two surveys were less positive with one of these saying that the person never liked their meals. The people we spoke with had a range of views about the Care Homes for Older People Page 16 of 29 Evidence: food from being good to being tasteless We saw the staff sitting down when helping people with their food and plate guards were available, to keep the food on the plate and to help people maintain their independence in eating. The AQAA noted that there has been an improvement in how breakfasts are now served in the dining area for those people who wish to eat there, rather than in their room.We saw a letter from the Manager to the staff stating that this improvement had been successful. The menus showed that the people are offered food and drink throughout the day and, during the evening lunch boxes are given out by the staff at supper time for any of the people who want these. Staff told us that the content of these change each week with a range of cheeses, crackers, cakes and fruit. According to the staff twenty-five lunch boxes were made up, for the 20th April 2009, and five unused lunch boxes were returned to the kitchen the following day. Care Homes for Older People Page 17 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are listened to and systems are in place to reduce the risk of abuse. Evidence: The AQAA told us that, within the last 12 month, the home had received 17 complaints, all of which had been resolved within the required 28-day time period and 10 of these had been proven. We examined the record of complaints and found that the complaints had been responded to within the required 28-day time period and none of the complaints had significant recurring themes. The majority of the residents surveys said that the person knew who to speak to if they were unhappy about something; felt that they were listened to and the staff acted on what was said to them and there was the knowledge of how to make a complaint. The staff survey said the person knew what to do if any concern about the home was made to them. We have received two complaints, since our inspection in August 2008, and we referred these to the appropriate agencies. Subsequent to our referrals the Manager told us that the home has investigated one of these complaints and found no evidence to uphold the complaint. The remaining complaint was investigated by an external agency and there was no evidence, also, to uphold this complaint. The AQAA noted that, within the last 12 months, the home has been subjected to six safeguarding investigations (Safeguarding was previously referred to as protection for Care Homes for Older People Page 18 of 29 Evidence: vulnerable adults or POVA). Of these six we can report on the outcome of three of these: for the first one member of the staff was dismissed following the homes investigation; for the second there was insufficient evidence to prove or otherwise the allegation with the outcome being considered as inconclusive and for the third the allegation was proven that there had not been appropriate care provided to prevent a person developing a pressure sore. The home has co-operated fully during these safeguarding investigations and enquiries. Since we received the AQAA and completing the Annual Service Review (ASR) we attended a safeguarding meeting, on the 13th March 2009 during which it was concluded that the home had acted on a number of concerns, such as the delivery of hot water to a persons room and the provision of a foot stool. It was also concluded that an allegation that a persons bed was missing a mattress (the person was lying on comfort mattress that should have been placed directly on a normal mattress) was proven although there was no evidence to support the allegation that a person was not given enough food or drink. We spoke with some of the staff who told us that they had attended safeguarding training and they knew what they would do if they witnessed or suspected abuse against any of the residents. The staff training records indicated that the majority of the staff have attended training in safeguarding and, according to the Manager, arrangements are in place for the remaining staff to attend this training. Care Homes for Older People Page 19 of 29 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a clean and generally comfortable place. Evidence: Outside we noted that the main fire escape was clear of debris and, since our last key unannounced inspection, in April 2008, gravel had been put down on garden borders to provide a tidy appearance for people to see out of their bedroom windows. Safety rails had also been provided to help people go over steps and also when using a ramp to enter or leave the inner courtyard. An almost full waste skip was located in the main car park, in view of the main entrance to the home and we discussed possible relocation of the skip with the Manager. The AQAA told us that there is an ongoing refurbishment programme to include the replacement of carpets when needed and we saw that this was the case in reports made by the Regional Manager. We noted that some areas of the home are in need of redecorating, such as toilets, bathrooms and corridors and we saw that these issues had been recorded in the Regional Managers reports for January and February 2009 and within the residents and relatives meeting held in February 2009. We asked for action to be taken, in our report of the inspection of the 8th April 2008, for the staff to be mindful of the quality of the lighting in peoples rooms and we saw that these rooms, where sun light is limited, had bedside lights on. We saw, from our examination of service records, that the heating and water system has been attended Care Homes for Older People Page 20 of 29 Evidence: to by plumbers to improve the delivery of hot water flow to all areas of the building. Examination of the record of hot water temperatures indicated that action is underway to install appropriate regulating hot water valves. The temperatures of hot water, in bathrooms, were delivered at a safe level, not exceeding 43 degrees centigrade. All of the eight residents surveys said the home was always or usually clean and fresh and we found that any fresh odours had been eliminated by the work of the domestic staff, before we left the home. Care Homes for Older People Page 21 of 29 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that they are cared for by generally competent staff although the residents are at some risk to their safety from unsuitable staff. Evidence: We timed some of the response of the staff to call bells and the time ranged between one and five and half minutes. Although we considered, in our Annual Service Review (ASR) that there had been a high turnover of staff the manager informed us that since November 2008 this turnover has slowed down with only three members of staff leaving, for valid reasons. A member of the staff told us that the staff morale and the staff team are good. The home has 33 of care staff with the National Vocational Qualification (NVQ) or level 2 in care. This remains the same as we found at our key inspection in April 2008. According to the Manager five other staff are to commence this NVQ training. In our report of the key unannounced inspection of the 8th April 2008, we recorded that the home must provide written explanations of any gaps in the staffs employment history. We examined two staff recruitment files and we found all the required information with the exception of the the following: there was no application form in either of the files, to provide evidence of the persons employment history. Although one of the staff files had a curriculum vita that provided the persons Care Homes for Older People Page 22 of 29 Evidence: employment history the last recorded date was 2006. This person also had no record of the result of their criminal record bureau check although the person had been working at the home since the 25th September 2008. The Manager examined these staff files and agreed with our findings. We were informed that there were no records, other than those we had examined, kept elsewhere in the home. We have made a requirement about staff information. The staff, including the Manager, told us, and from our examination of the staff training records, that staff have opportunities to attend training in areas such as food hygiene, infection control, care of a person with artificial feeding methods, care of some one with a catheter and care of some one with Parkinsons disease. Care Homes for Older People Page 23 of 29 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. People benefit from a generally well-managed service. Evidence: The Registered Manager, a Registered General Nurse, has worked at the home, in her current position, since June 2006 and has demonstrated that, under her management, Ringshill Nursing Home has improved in its standard of care and in the standard of health and safety over the last three years. She is supported by the Regional Manager and attends meetings with other Four Seasons Health Care Limited home managers. Currently a vacancy has arisen for a deputy manager. Copies of reports made by the Regional Manager, for visits made in January and February 2009, were seen to demonstrate that audits are carried out for areas such as care records, records of complaints, the condition of the premises and records are made of the views of residents and staff that the Regional Manager had spoken to. The home holds Quality and Clinical Governance meetings and a record of the last meeting was seen in which areas were discussed where the home could improve upon, Care Homes for Older People Page 24 of 29 Evidence: such as the environment and care. The AQAA was completed in a satisfactory manner and told us where the home had improved and areas where further improvements could be made. Four Seasons Health Care Limited sent out surveys to relatives, in November 2008 and the home received the results, in January 2009.The AQAA told us that an action plan was to be developed, following the results of these surveys. Records were examined of any of the residents personal monies and, in discussion with the staff, it was found that there is an audit trail of invoices coming in, receipts going out and cheques being paid in. Records for safety checks for portable electrical appliances, hoists, including fixed bath hoists and emergency light checks were satisfactory. According to the fire safety records seventeen people attended the last fire drill carried out on the 7th January 2009 and the staff training files indicated that all the staff have attended fire safety training within the last twelve months. The staff we spoke with said that they had attended training in fire safety and moving and handling. The staff training records indicated that the majority of the staff have attended training in safe moving and handling. According to the Manager certificates for this training, attended by other care staff, had arrived at the home, although this information had yet to be updated on the staff training records. We found a a plastic, unlabeled bottle of pink liquid, in an unlocked sluice room. A member of the staff told us that this liquid was disinfectant and said that the bottle should be locked away. Later in the day we found that this bottle of pink liquid remained in the unlocked sluice cupboard that was accessible to any of the residents. We expect the home to manage this issue, rather than we make a requirement on this occasion. Examination of the records for fire alarm tests were examined and the last test was recorded as being carried out on the 16th March 2009. According to the Manager these tests must be done on a weekly basis. She found no other record of any later tests and informed us that she had not heard the fire alarm test when she had been at the home, although she reported that she is not at the home all the time. We have made no requirement on this occasion as we expect the home to take action. The AQAA noted that 85 of catering staff and 25 of care staff have attended training in safe food handling and, according to the staff and the Manager, arrangements are in place for other staff to attend this training. In November 2008 the home was awarded four stars for the standard of food hygiene. Care Homes for Older People Page 25 of 29 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 9 12(1)13(2) Where residents are prescribed medication on a when required basis there must be detailed written guidelines for their use. Previous timescale of 31/05/08 not met. 15/05/2009 This will protect residents from harm and abuse. Care Homes for Older People Page 26 of 29 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 9 12 When people refuse to take their medicines this must be recorded, along with the reason why and reported to the prescriber. This will protect people from harm and ensure medication is taken properly. 15/05/2009 2 9 13 Medication must be given to people as prescribed and accurate records made to ensure an audit trail is complete. This will demonstrate that people receive their medicines as prescribed. 15/05/2009 3 29 19 Full and satisfctory 30/05/2009 information about staff must be obtained before they start to work at the home. This is to protect the people from any risk harm perpetrated by unsuitable staff. Care Homes for Older People Page 27 of 29 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 9 Hand-written changes or additions to medication instruction should be signed and dated by the person making the change and checked for accuracy by a second person who should also sign the form. Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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