Care Home: Ringway Mews Nursing Home

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What the care home does well The registered person ensures that the physical needs of service users are fully assessed before they move into Ringway Mews, this is so they can begin to receive effective care and support promptly. The registered person ensures that service users receive medical care when they need it. The registered person makes sure that medication is managed safely at Ringway Mews. The registered person makes sure that complaints, concerns and allegations are handled openly and in keeping with guidelines for the safeguarding of vulnerable adults. The registered person ensures that staff have opportunities for training directly related to the needs of service users. The registered person ensures that staff are employed using a robust recruitment process this is to promote the employment of people suitable for working with vulnerable adults. What has improved since the last inspection? Since the last inspection Halifax unit has had the public areas re carpeted. Since the last inspection a refurbishment programme has started at Ringway Mews. What the care home could do better: The registered person should ensure that systems are in place to ensure that service users are treated with dignity, respect and concern from the moment they enter Ringway Mews, this will help them to settle in more quickly and reduce the risk of anxiety and confusion. The registered person should ensure that opportunities for activities and recreation are frequent, varied, and meet the service users individual interests and needs. Activities should also acknowledge people different group identities. This is so that, service users remain motivated, have continued opportunities to enjoy themselves, have a sense of purpose and, maintain an interest in their own life, other people and, the world around them. The registered person should take steps to promote choice at mealtimes by ensuring that information is always available to staff and service users in a format that is readily accessible to them. This will help to give autonomy as it will give service users some control over this aspect of their day. The registered person should br able to show that service users are offered sufficient drinks during the day so that people remain hydrated according to their needs. The registered person should ensure that the home is maintained in a clean and hygienic state, free from dirt and unpleasant odours. This is so that people live in a pleasant environment and to prevent avoidable illness caused by cross infection. The registered person should ensure that a minimum ratio of 50% of care staff is trained to National Vocational Qualification in Care Level 2 or above as quickly as possible. This will professionalise care staff and help them to understand the importance of, and how to, always comply with the information they are given. Key inspection report Care homes for older people Name: Address: Ringway Mews Nursing Home Stancliffe Road Sharston, Wythenshawe Manchester M22 4RY     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: Michelle Haller     Date: 1 7 0 2 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 33 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 33 Information about the care home Name of care home: Address: Ringway Mews Nursing Home Stancliffe Road Sharston, Wythenshawe Manchester M22 4RY 01614914887 01614286991 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: www.bupa.com BUPA Care Homes (CFHCare) Ltd care home 150 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The registered person may provide the following categories of service only: Care home with nursing - Code N to service user of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Dementia - Code DE The maximum number of service users who can be accommodated is: 150 Date of last inspection Brief description of the care home Ringway Mews is a care home providing nursing care and accommodation for a maximum of 150 older people. Within this maximum number, accommodation is provided for 30 older people with dementia type illnesses. However, one of the houses that provided nursing care was currently closed. The home is owned by BUPA Care Homes. The home is situated in the residential area of Wythenshawe, which is to the South of the City of Manchester. There is easy access to the Manchester ring road motorway system as well as easy access to public transport systems, which are within walking distance of the home. There is ample parking within the grounds of the home. Care Homes for Older People Page 4 of 33 Over 65 0 150 150 0 Brief description of the care home Wythenshawe Civic centre is easily reached by car and there are local shops, which are within walking distance of the home. The home is purpose-built and consists of 5 separate single storey houses. Each house provides accommodation for 30 residents and stands within its own garden area. The administration area, laundry, hairdressers, and central kitchen are housed in a central building that is accessible by a covered walkway. The charges for fees range from GBP397-88 to GBP651-51 per week. There are additional charges for magazines, papers, hairdressing and Chiropody. Care Homes for Older People Page 5 of 33 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 conducted this inspection by visiting the home without informing the manager before hand, and we looked at all of the most important or key Care Homes for Older People National Minimum Standards (NMS). This is called a Key Inspection. The inspection involved looking at the information we had received about the service during the previous year and before visiting the home. This included notifications or events that the manager has told us about, information from other sources such as social services, health workers or people using the service. We considered the outcome of the previous Care Quality Commission (CQC) key inspection conducted in 2008 and a Random Inspection in December 2009. We received three completed Care Quality Commission (CQC) surveys from staff. We did not receive any surveys from service users. Care Homes for Older People Page 6 of 33 We visited Ringway Mews and looked around the home and checked through written information, including service user care files and staff employment records. We read through policies, guidelines and other documents concerned with running the home. We also talked to residents, their relatives and staff working at the home. We observed the interactions between service users, staff and others. We interviewed the manager and talked to the registered provider. The manager returned to us the CQC Annual Quality Assurance Assessment (AQAA). The information requested included data about staff training, development of policies and procedures and, compliance with health and safety checks when applicable. This information also influenced the outcome of the inspection. An expert by experience inspector was also present and their information has been used to inform the findings of this inspection. An additional CQC inspector also participated in this inspection and her findings are also included in the report. Care Homes for Older People Page 7 of 33 What the care home does well: What has improved since the last inspection? What they could do better: The registered person should ensure that systems are in place to ensure that service users are treated with dignity, respect and concern from the moment they enter Ringway Mews, this will help them to settle in more quickly and reduce the risk of anxiety and confusion. The registered person should ensure that opportunities for activities and recreation are frequent, varied, and meet the service users individual interests and needs. Activities should also acknowledge people different group identities. This is so that, service users remain motivated, have continued opportunities to enjoy themselves, have a sense of purpose and, maintain an interest in their own life, other people and, the world around them. The registered person should take steps to promote choice at mealtimes by ensuring that information is always available to staff and service users in a format that is readily accessible to them. This will help to give autonomy as it will give service users some control over this aspect of their day. The registered person should br able to show that service users are offered sufficient drinks during the day so that people remain hydrated according to their needs. The registered person should ensure that the home is maintained in a clean and hygienic state, free from dirt and unpleasant odours. This is so that people live in a Care Homes for Older People Page 8 of 33 pleasant environment and to prevent avoidable illness caused by cross infection. The registered person should ensure that a minimum ratio of 50 of care staff is trained to National Vocational Qualification in Care Level 2 or above as quickly as possible. This will professionalise care staff and help them to understand the importance of, and how to, always comply with the information they are given. 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 33 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 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The wellbeing of service users is promoted because, their health and emotional needs are fully assessed and confirmed as been able to be met at Ringway Mews. Evidence: We looked at four care plans in detail and found that prospective clients receive thorough pre-assessments before been accepted to live at Ringway Mews. We saw that assessment had been completed by experienced staff who visited each perspective service user. The staff completed a pre-admission checklist and assessment through talking to current staff, including nurses and social workers. The staff also met with the potential resident and their relatives. We were informed and saw written evidence that if the needs of the service user appeared particularly complex then the assessments were discussed in further depth with more senior clinical staff. The assessments included information about peoples personal health and physical Care Homes for Older People Page 11 of 33 Evidence: well-being, weight and diet, sensory needs and communication, mobility and falls risk, medication and mental state. We saw that peoples needs were reassessed close to six weeks following their admission and changes made to care plans as required. In the Annual Quality Assessment the manager sent to us we were informed that planned improvment for the coming 12 months included: Working with outside agencies to assist staff to document more fully and in a person centred way. Staff told us, in the surveys they returned, that they always received sufficient information to meet peoples needs. Care Homes for Older People Page 12 of 33 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. Ringway Mews has systems in place which promote effective health and personal care. Evidence: We looked at the care plans for five people. We found that, in relation to health needs, these care plans provided staff with information about how to meet peoples needs. We found from signatures and from what was written, that service users or their relatives had been informed about the care plans. We noted that, in the main, the care plans addressed the physical and mental health needs identified during the assessment. We noted that most of the care plans that we looked at had been reviewed to reflect changes in health needs. The information was person centred and individualised reflecting to some extent the wishes and personality of the service user. We saw that risk assessments were developed. We found that pressure area care was effective in that at the time of the inspection we were informed that no one in the home was been treated for pressure sores acquired Care Homes for Older People Page 13 of 33 Evidence: at Ringway Mews. We checked the pressure area care plan for two people on specialist mattresses, and found that neither included information about the setting the pressure mattresses should have been on. We looked and both had been set on high. We requested that this issue should be checked and any adjustment required made. The correct setting should also be included in the pressure area care plan so that this information is written for staff to see. We saw that moving and handling assessments were in place and in some cases the instruction to staff was very detailed and if followed would keep the service user and the staff safe from harm. We saw that service users have good access to medical and health care. We saw through records that people are supported to attend outpatient appointments. We also noted through completed prescriptions and other correspondence that people received routine health checks and treatment including the influenza vaccine, optician checks and chiropody care. We found that The Homes Nursing Service from the primary care trust, provides frequent input into Ringway Mews, and so staff are able to get advice from them if they have any concerns. We looked at the management of medication through, observing a medication round, examining the medication records and the storage of medication on one unit. We found that the records were accurate and that all medication was securely stored and administered as prescribed. We did note, however, that medication rounds could take a long time in that medication was still been administered at 10:30 on one unit. We discussed this issue with the registered provider who agreed that the matter would be monitored and a solution found in keeping with BUPA protocol. We observed staff and service user interactions, and the general demeanour and appearance of people living and working at Ringway Mews. We noted that in the main people looked comfortable, however there were observations that indicated that people were not always treated as individuals or with due care and attention. We saw that on one unit many of the service users were wearing the same style pink fluffy sock slippers. We have been informed that the residents have purchased these items from a retailer who visits the home. We would suggest that an element of advocacy is introduced to ensure that the retailers stock is more varied so that people Care Homes for Older People Page 14 of 33 Evidence: dont end up choosing the same items and so lose their identity and become institutionalised. We also noted, as we went around the units that a significant number of people were not wearing socks, stockings or tights we have been informed that the service users have chosen to go without these items of clothing. We noted that one person had been admitted to a unit from hospital, we observed this person for approximately 45 minutes and found that in this time they were not supported in a way that would promote a sense of belonging or wellbeing. This is because the person was sitting in a wheelchair, he was dressed in a hospital gown and had a small blanket wrapped about him. The person was not placed near a table or where he could see a television or relate to other service users. Furthermore, throughout this time, staff and service users passed around him as though he wasnt there. We saw that when staff did speak to him he was asked a question without an introduction or explanation. We assess that this demonstrates that people who are at their most vulnerable are not always treated with due consideration and concern at Ringway Mews. The ex-by-ex, however, observed good communication between staff and service users she described how care staff worked effectively with a distressed service user:One person was very distraught, bitterly complaining that she had lost all her jewelry and her watch had gone missing. The watch was shortly brought for the resident who was very elated and who thanked the carer. In the AQAA she returned to us the manager stated that planned improvements for the coming year included, as a continued drive to wards building on current effective : The introduction of robust review of personal risk assessing, and to continue further staff training to consolidate previous learning through reflection and supervision. We asked the Expert by Experience to find out about the experience that people living at Ringway Mews may have. The ex-by-ex stated that she talked to most of the residents on Lancaster unit. The ex-by-ex also noted that most residents were well groomed. The ex-by-ex also said that Staff were polite when communicating with residents. We also asked the ex-by ex to find out what the service users experience was in Care Homes for Older People Page 15 of 33 Evidence: relation to meals and drinks, she wrote: They (the service users) complained that they rarely get a mid-morning drink. I did observe a glass of juice given to residents, but those in their rooms were not offered a drink. No snacks or fruit was offered. People we talked to said the staff were lovely and that staff treated the residents with respect and patience. Relatives commented that: We can ask questions of the trained staff and they will always answer it- we never feel fobbed off. Care Homes for Older People Page 16 of 33 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. The routines at Ringway Mews are flexible however day to day leisure activities are ill prepared. Evidence: We found, from information provided by service users and staff, that people would like activities to be more varied and frequent. Staff did tell us that service users could play bingo, card games, have one to one sessions and look through the reminiscence book. We also found that staff did not always consider peoples experiences, either as a group or individually, and so they paid little attention to the activities they provided. For example, on one unit we noted that the same CD played 3 times and the music was all old and wartime songs. Staff did not consider that this might not be all that was listened to by people who were in their 20s or 30s in the 1950s and 1960s. We also saw, from observing an activity session that these could be better organised. We observed, for a short while, a game of Play Your Cards Right. We noted that the staff leading the game had set up in front of a television that was still switched on, meaning that if someone wanted to watch the television they couldnt, but also people who wanted to play the game would be distracted. It also indicated that staff had not Care Homes for Older People Page 17 of 33 Evidence: asked people who might have been watching television whether they wanted to continue watching TV so that it could be switched off. We found that there were no restrictions on visits to the Ringway Mews and families and friends found the staff helpful. We found that people were able to get up and have their meals in their own time and that the routines in the home were flexible. We examined the menu and noted that this was varied and offered a variety of traditional British foods such as stews, hashes and roasts. Soup was served each day, as was a choice of salad. We found that service users were not always aware that they could have a choice of meal, although if they did not want was sent across at the mealtime then an alternative was offered. We found that service users and staff on Lancaster House did not know what was on the menu on the day of inspection and this information was not available in a accessible format or prominently displayed. We noted that although menus were available these were in very small print. We found that the dining experience for service users could be improved if tables were set with condiments, cups and saucers or glasses, ready for the meal. We noted that a number of people sat at the dining table in their wheelchairs. The registered person should consider whether this is aways appropriate as sitting in an ordinary chair could be more pleasurable for the people concerned. We found that a significant number of service users living at Ringway Mews may not always be offered frequent fluids, as it was noted that routine drinks were not offered to all service users on two of the units. Discussion with the registered provider identified that different distribution methods are used on these units. It is essential the registered person is able to demonstrate that the system in place ensures that everyone is supported to have sufficient liquids to keep them free from the effects of dehydration. The registered person needs to ensure that it can be demonstrated that every service user is offered the Food Standard Agency recommended daily fluid intake of approximately 1.5 litres or 6 - 8 cups each day, but in consideration with individual health matters. In the AQAA the manager returned to us she stated that improvements planned for the coming year included: Working closely with the newly expanded corporate activities team, developing life story work within the home to ensure provision of Care Homes for Older People Page 18 of 33 Evidence: relevant meaningfully activities and improved documentation of the individual activities undertaken. We asked the Expert by Experience to find out about peoples thoughts and experience with regards to the lifestyle they led at Ringway Mews and so she spent her time on Lancaster unit and the ex-by-ex confirmed that she had spoken to most of the residents there. About food, her report she said: Residents said that they enjoyed their meals. The meal served was not elaborate but good, most residents requested second helpings. Vegetarian meals are also provided. Residents felt that they were not given a choice of meals. There was a menu on display but residents seem to be unaware of this. The menu identified was not easily accessible nor easily legible. About activities her report said: Visitors are encouraged to visit, there is no restriction. The activities coordinator was introduced to me and throughout the time i spent there no activity was was done. The residents spoke of boredom and said that all that happens is a weekly bingo session and sometimes they have the opportunity to use the Wii games console. One resident said that she always looked forward to the weekly visit by the clergy but for sometime there had been no visit. People who we talked to made positive comments about staff attitude and the meals provided at Ringway Mews, they said: Our parents only ever have good things to say about the unit (Wellington). They seem to enjoy the food and Dad will say what they eat- staff seemed to know what they have eaten, they stick to their usual pattern of soup and sandwiches at lunch time. The ex-by-ex also stated that another service user said that they had A new outlook on life since living in the home because previously she had never had a manicure or been to a hairdresser. Care Homes for Older People Page 19 of 33 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. Service users at Ringway Mews have access to a complaints and safeguarding policies and guidelines which will ensure that complaints, concerns and allegations are openly and thoroughly investigated in a manner that is fair and supportive to all concerned. Evidence: We found that people were provided with information about how to complain and make their concerns known. We saw that if people were dissatisfied with the outcomes of the initial investigation then BUPA provided easy access to different stages of appeal. We noted that two separate flow-charts, explaining the actions required of staff in respect of reporting and dealing with incidents and how to deal with safeguarding were posted in the offices of Lancaster and Shackleton Units. We found, through cross-referencing information on the units, the information in the main office, information provided to CQC and to the local authority that, in the main, the manager kept statutory services informed about incidents and unusual occurrence that happened at Ringway Mews. We found, however, that this was not the case for service users on the Wellington unit. We discussed this matter with the registered manager and the registered person and they agreed that Care Standard Act 2000 Regulation 37 notifications would be sent to CQC. This is so that all incidents that occur at Ringway Mews are recorded and Care Homes for Older People Page 20 of 33 Evidence: monitored in the same way, and dealt with in keeping with good practise in relation to complaints, concerns and allegations. At the time of this key inspection there were three adult protection incidents been investigated at Ringway Mews. We discussed the application of the Mental Capacity Act (MCA) 2008 and Deprivation of Liberty Safeguard (DoLs) guidelines. We were informed that BUPA have a corporate policy and dedicated team for these matters. The manager stated that in relation to DoLs, she was currently involved with one service user, the Independent Mental Capacity Advocate, the persons family and their social worker to consider whether the support needed should be dealt with under Best Interest guidelines or whether a Dols referral was required. The manager confirmed that she would inform CQC when the MCA and DoLs guidelines were actually invoked for anyone living at Ringway Mews. We looked at the training calender and talked to staff about adult protection matters. We found that the majority of staff had received adult protection training and refreshers in 2008 and 2009. However, there was also a significant number of staff who had last received training or updates in 2006 and 2007. We understood from the manager that safeguarding adults training is a priority for staff and that a rolling programme has been commenced. Staff who were spoken to were clear about behaviours that needed to be reported although they were not always certain about what to do if they felt issues had not been dealt with correctly. We found through examining records of investigations and supervision regarding staff conduct, that the manager promotes an environment in which staff felt comfortable and supported to highlight when errors and mistakes were made. This is important because it means that matters could be remedied and dealt with quickly and openly. In the AQAA information she returned to us the manager stated that plans for the coming year included: We look to continue working in partnerships with residents, relatives and outside agencies to further develop our practises. We anticipate this will reduce complaints and improve resident satisfaction and quality of life. Relatives told us that: If we had any concerns would talk to the Sister or a Staff Nurse. They are always very good - the Staff Nurses. Care Homes for Older People Page 21 of 33 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. Ringway Mews is been refurbished so that the environment is pleasant and comfortable for service users. Evidence: We found through examining the refurbishment plan that all of the units will be redecorated, including the replacement flooring, furniture and soft furnishings. We assess that when this process is completed the environment will be pleasant place to live. We found that most of the communal areas in each unit was dirty, grubby and unpleasant. Shackleton, Wellington and Halifax held a distinctly unpleasant odour. Toilet areas were dirty and flooring in some areas was sticky. We saw on two occasions ancillary staff failing to adhere to basic guidelines in relation to infection control at the home. The refurbishment program has commenced on Anson unit. We asked the ex-by-ex to look at environment and reflect what people told her about the environment. She spent her time on Lancaster unit. In her report she stated: Care Homes for Older People Page 22 of 33 Evidence: All the areas are well lit and surrounded by well maintained gardens. A smoking area is provided. However on entering the building there is a strong unpleasant smell. The overall cleanliness could be improved, the net curtain in the dining room was quite dirty. The rooms were personalised to individual preference. Residents their own room keys for added security. There are no en-suite facilities and there is a lack of adequate storage. The shelf are is very cluttered with toiletries pushed in a bowl. Care Homes for Older People Page 23 of 33 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. The staff at Ringway Mews are supported to meet the needs of the service users. Evidence: We discussed staff deployment and accepted that the numbers of care staff on duty on each unit were sufficient to meet the care needs of the service users. We observed that domestic staff did not do a very effective job in keeping the units clean, tidy and free from unpleasant odours. We were informed that there was always a senior staff on duty in the units and in the evening, weekends and when the registered manager was unavailable a qualified nurse provided cover of the site. We examined the staff files for each of the unit managers at Ringway Mews. And we looked at the training record for all staff and we discussed the qualifications that all staff working for the home have attained. We found that all files held original application forms, references and confirmation that Criminal Record Bureaux (CRB) checks and Protection of Vulnerable Adults (POVA) checks had been completed. Pictures of all staff were also in place. Care Homes for Older People Page 24 of 33 Evidence: Staff who returned surveys confirmed that recruitment was thorough and all checks were completed prior to them taking up employment. We found that unit managers received the following training: digital rectal evacuation, falls prevention; hand-washing (28/01/10); swine flu/infection information; In-house POVA as a reminder to staff of the services policies and procedures; medication training which entailed 500 hours of training through completing a workbook; managing swallowing conditions; falls prevention; catheterisation; continence; leg ulcer management; Pressure Area Care; syringe drive and venupuncture; Mental Capacity Act (MCA) 2008; Fire Safety and People handling and risk assessment. We found that unit managers were responsible for the day to running of the units with reference to the quality of assessments, health and social care, lifestyle and dealing with initial complaints and concerns for service users on their units. We found that they were responsible for the day to day management of junior care staff and domestic staff working on each unit. We found that the registered manager and the clinical service manager were involved with the audit of the quality of care plans and took responsibility for driving forward improvements and the performance in relation to the care of service users and the over all running of the site. We found that unit managers received frequent supervision about the work they did and were kept up to date with the standard that was expected. We asked the unit managers about the management training they had received and we found that one person out of five felt that they had completed a management course which prepared them for managing staff. And one had management experience. We found that three unit managers had completed in-house training about managing absence. We read through the supervision records for the unit managers and observed that there was a time when it was felt that junior staff did not always work to an acceptable standard when the unit manager was not on duty. We discussed the issue of management on the units with the registered manager and the registered provider for Ringway Mews. The registered provider told us that BUPA was currently piloting a management training course for unit managers in some of their homes. She felt that if this scheme Care Homes for Older People Page 25 of 33 Evidence: proved successful it might be extended to other homes in order to consolidate good practise. We acknowledged that we saw evidence of good communication, auditing, supervision and training provided to staff and assessed that these structures should help to bring about the smooth running of the home, resulting in the needs of the service users been met to a high standard. However, on a number of occasions, we observed that care staff and ancillary staff did not carry out basic instructions or always keep to the rules and guidelines that were in place. We assess that this lack of attention to detail, by some employees, means that it is difficult to be confident that the best outcomes for service users will always be promoted and achieved. We discussed staff qualifications and found that approximately 33 of care staff have attained National Vocational Qualification (NVQ) in care level 2 or above. The minimum acceptable percentage is 50 .The registered person informed us that NVQ training was provided on a rolling programme. We were informed by staff who returned surveys that BUPA provided them with opportunities to participate in training that was relevant to their role and kept them up to date with new ways of working. We discussed whether the BUPA staff development initiative Personal Best would be implemented for staff at Ringway Mews. This initiative, which is award winning and exclusive to BUPA, has helped to raise service user satisfaction in other BUPA homes and, would involve all members of staff in the training programme, not just care workers; would share ideas and methods of good practise with other care homes; would assess the individual strengths and interests of all staff; would set personal plans for each staff member with achievable targets and recognise their success through reward schemes. We found that this scheme was currently up and running at Ringway Mews. In the AQAA the manager stated that planned improvements for the coming year included: Continued recruitment and selection of excellent staff, subject to all necessary preemployment procedures; continued development of all staff grades throughout the home, consolidation of learning through reflection and supervision and relaunch Care Homes for Older People Page 26 of 33 Evidence: Personal Best programme. Care Homes for Older People Page 27 of 33 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. The management and administration of Ringway Mews aims to achieve a service that consistently serves the best interest of people involved with the home. Evidence: We found that Adrienne Gresty has good management experience and has worked for BUPA in a management capacity for significant number of years. She completed the registered manager registration for Ringway Mews in August 2009. We have found Ms Gresty to be open and responsive in working with CQC and dealing with incidents and events that have occurred at Ringway Mews. She provides staff with instructions and guidance about how the units should be run. We found that in supervision she highlights what is working well and what might need to be changed. Staff who commented feel that the manager is approachable and they were aware of the lines of accountability in the home. BUPA expect the registered managers to audit the compliance of staff in relation to their roles. We found that Care Plan audits were been completed. We saw that, considering the length of time that these had been in Care Homes for Older People Page 28 of 33 Evidence: use and the training available, there were times when a substantial amount of omissions and incomplete sections were discovered on forms. We found that the management team responded quickly to concerns, and put in place action plans which have been adhered to, and helped to raise staff awareness and performance in the areas that have been highlighted. However we assess that these changes need to be embedded into the culture of Ringway Mews so that there is evidence of sustained improvement. We discussed quality monitoring with the registered manager and the registered person. We were informed that BUPA conduct a corporate Customer Satisfaction assurance audit that includes all of their care homes. The results are published yearly. We were informed that Ringway Mews also conducted its own quality audit in relation to the service users. However, we found that people who were spoken to were unaware that there were opportunities for them to comment on the quality of the service or be involved with any development plans. We found that a significant number of polices and procedures used in the home had not been reviewed since 2006. We were informed that BUPA were in the process of updating the polices and procedures. We were informed that BUPA periodically send updates for some policies. It is expected that the manager replaces the old information which is then destroyed or returned to head office. We found that there is a robust system for dealing with service users money. We were informed that very little money cash is used on site. We were informed that at present the system is that cash is paid in at the office and entered into the computer accounting system. There is a bank statement available identifying each persons balance. We saw by examining the maintenance manual presented to us by the site manager at Ringway Mews. We saw that all of the certificates for maintenance and safety checks were in place and within the expected date including hoist, gas safety, electrical safety and fire safety, were all up to date and in keeping with the recommendation and requirements of relevant guidance. In the AQAA that was returned to us the manager stated that planned improvements included: Continue development of of Personal Best across the site, encourage further NVQ training for staff and utilise information gained from Customer satisfaction survey. Care Homes for Older People Page 29 of 33 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 30 of 33 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 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 10 The registered person should ensure that systems are in place to ensure that service users are treated with dignity, respect and concern from the moment they enter Ringway Mews, this will help them to settle in and reduce the risk of anxiety and confusion. The registered person should ensure that opportunities for activities and recreation are frequent, varied, and meet the service users individual interests and needs. Activities should also acknowledge people different group identities. This is so that, service users remain motivated, have continued opportunities to enjoy themselves, have a sense of purpose and, maintain an interest in their own life, other people and the world around them. The registered person should be able to show that service users are always offered sufficient drinks during the day so that people remain well hydrated according to their needs. The registered person should take steps to promote choice at mealtimes by ensuring that information is always available to staff and service users in a format that is readily accessible to them. This will help to give autonomy as it will give service users some control over this aspect of Page 31 of 33 2 12 3 15 4 15 Care Homes for Older 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 their day. 5 26 The registered person should ensure that every part of each unit is kept hygienically clean so that service users live in a home that is pleasant, comfortable and free from bad odours. The registered person should ensure that a minimum ratio of 50 of care staff is trained to National Vocational Qualification in Care Level 2 or above as quickly as possible. This will professionalise care staff and help them to understand the importance of, and how to, always comply with the information they are given. 6 28 Care Homes for Older People Page 32 of 33 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). 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