Care Home: Rufford Care Centre

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What the care home does well This is a large care home, with 100 bedrooms. However efforts have been made to have smaller sitting and dining areas, so that the home feels more intimate, and people are not left feeling that they are in a large institution. A number of positive comments have been received from people who live at the home including: "The home is spotlessly clean. On the whole I think the staff know what they are doing some are more caring than others but that`s not a surprise." "Generally happy I`ve never heard a carer shout or be unkind Most carers are cheerful and singing occaissionally, you can have a grumble. They give help when I need it, and they never lose their patience with me, and they are never nasty." "I don`t think that there are enough staff, but I do find them usually helpful and thoughtful and kind. I feel comfortable with them not unhappy, and the staff would give help if I needed it." "The food is marvellous", and "the food is fine, it`s how I like it". "The meals served by the home have improved, we get proper food now". "My room is fine and I`ve got everything I need. I watch TV by myself if I want and all the mobility equipment is working OK". What has improved since the last inspection? Since the last key inspection there has been a new manager appointed, and a number of issues relating to staff recruitment have been addressed. This has seen several staff have their contracts cancelled, due to unsatisfactory Criminal Records Bureau checks, in an attempt to ensure that the people living at the care home are safe. Staff training has been reviewed, with a greater emphasis on ensuring that the mandatory training courses in food hygiene, moving & handling, fire safety and safeguarding adults are delivered to as many staff as possible. Some areas of the care home have been redecorated. What the care home could do better: Ten statutory requirements have been made as a result of this key inspection visit. These relate to: Ensuring that documentation within the care plans is complete and up to date. Ensuring that people living at the care home have a care plan detailing how their needs will be met. Making sure that risk assessments are in place when and where needed. Ensuring that the staff have full regard for the dignity and respect of the people who live at the care home. Checking that staff records comply with the regulations. Making sure the staff are suitably trained. The acting manager must apply to be registered with the Commission. Regulation 37 notification forms must be sent to the Commission to inform us of any death, or event that affects the welbeing of the people living at the home. Introducing a recognised Quality Assurance system. In addition eleven good practice recommendations have been made. These relate to: Every body who lives at the care home having a contract or a copy of the terms and conditions of residence. Carrying out Mental Capacity Assessments in line with the Mental Capacity Act (2005). Putting care plans in place, when an assessment identifies an area of need. Adopting a person centred approach to care plans and documentation. Supporting people to make decisions about their care. Making sure everyone has a care plan identifying their wishes at the time of their death. Putting in place a structured weekly programme of activities. Investigating the concerns raised by people who live at the home, and which have been raised in this report. Increasing the National Vocational Qualification (NVQ) training for staff. Making sure all staff have a minimum of six formal supervision sessions per year. Key inspection report Care homes for older people Name: Address: Rufford Care Centre Gateford Road Gateford Worksop Nottinghamshire S81 7BH     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Rob Cooper     Date: 2 1 0 1 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 35 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 35 Information about the care home Name of care home: Address: Rufford Care Centre Gateford Road Gateford Worksop Nottinghamshire S81 7BH 01909530233 01909533044 rufford@carecentre.wanadoo.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mimosa Healthcare Holdings Ltd care home 100 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: Clumber unit may accommodate service users within category Physical Disability 18-65 years (PD) 25 beds Hardwick unit may accommodate service users within categories Old age not falling within any other category (OP) 25 beds Dementia over 65 years of age (DE/E) 10 beds Service users shall be within categories DE/E (35), OP (50) or PD (25) The registered manager must be a 1st level nurse and full time, with full time supernumery hours Thoresby Unit may accommodate residents within categories Old age not falling within any other category OP (25) beds Unit managers are to have at least 2 days supernumery hours of work. Up to 4 beds for OP may be used for Terminally ill and up to 8 beds may be used for persons with dementia over 45 years of age. Care Homes for Older People Page 4 of 35 Over 65 35 50 0 0 0 25 Welbeck unit may accommodate service users within categories Old Age not falling within any other category (OP) 25 beds Dementia over 65 years (DE/E) 25 beds Date of last inspection Brief description of the care home Rufford Care Centre is a purpose built care home first registered in August 2003. It is owned and managed by Mimmosa Healthcare who purchased the home in April 2008. The home is situated on the Worksop bypass along Gateford Hill approximately one mile from the centre of Gateford. Rufford Care Centre is registered to accommodate up to one hundred service users, all in single occupancy rooms with ensuite facilities. The home is divided into four units that offer a specific specialist care service. Clumber Unit provides accommodation for up to twenty-five younger adults between the ages of eighteen and sixty-five. Hardwick Unit accommodates up to twenty-five service users over the age of sixty-five who require twenty-four hour nursing care and who have Dementia. Thoresby Unit has a total of twenty five places for residential placements and the Welbeck Unit supports people suffering from varying degrees of Dementia, The Care Centre has been designed so that each unit can run independently with their own communal settings. The catering and laundry services are based within the basement of the centre and they provide a service across the four units. The acting manager said that the homes current weekly fees range from £300 to £1,222.22. Hairdressing and chiropody fees are not included. Care Homes for Older People Page 5 of 35 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This was an unannounced visit as part of the key inspection process, so that no one at Rufford Care Centre knew that the inspection visit was going to take place. The visit took approximately seven hours through the middle of the day, with three inspectors present. In preparing for this inspection, the information that the Commission holds about this care home was reviewed, this included looking at the last inspection report, the inspection record, considering any complaints or concerns that have been made about the service, and reviewing any notifications made relating to incidents that affect the well being of people living at Rufford Care Centre. Care Homes for Older People Page 6 of 35 The methods used during this key inspection and site visit were to visit the care home, where a method called case tracking was used; this involved identifying four people who live at the care home and looking in depth at their individual files and making a judgement about the quality of care they are receiving, and if their needs are being met. In addition one inspector carried out a Short Observational Framework for Inspection (a SOFI) which involved the inspector sitting in a communal area of the home for two hours and making notes about what happened there during that time. We also carried out a partial tour of the building, looking at the activities on offer, and talking to several people who live there, together with members of staff about the quality of the service, and their experiences of living and working at Rufford Care Centre. We also sent out an Annual Quality Assurance Assessment (known as an AQAA), which allowed the care home to carry out a self-assessment; and provide a range of information relating to their service. Information provided by them in their AQAA helped to form the judgements in this report. We also handed out a number of questionnaires asking for views and information to people who live at the home, and to staff on the day of the inspection visit. The information received from those questionnaires also helped with the judgements that we made. The acting manager Gilian Lindley provided much of the information during this key inspection visit. On the day of this inspection there were sixty seven people living at the care home. People who might want to live at this care home can obtain information about it direct from them, and this would include seeing previous inspection reports prepared by the Care Quality Commission. Care Homes for Older People Page 7 of 35 What the care home does well: What has improved since the last inspection? What they could do better: Ten statutory requirements have been made as a result of this key inspection visit. These relate to: Ensuring that documentation within the care plans is complete and up to date. Ensuring that people living at the care home have a care plan detailing how their needs will be met. Making sure that risk assessments are in place when and where needed. Ensuring that the staff have full regard for the dignity and respect of the people who live at the care home. Checking that staff records comply with the regulations. Making sure the staff are suitably trained. The acting manager must apply to be registered with the Commission. Regulation 37 notification forms must be sent to the Commission to inform us of any death, or event that affects the welbeing of the people living at the home. Introducing a recognised Quality Assurance system. In addition eleven good practice recommendations have been made. These relate to: Every body who lives at the care home having a contract or a copy of the terms and conditions of residence. Carrying out Mental Capacity Assessments in line with the Mental Capacity Act (2005). Putting care plans in place, when an assessment identifies an area of need. Adopting a person centred approach to care plans and documentation. Supporting people to make decisions about their care. Making sure everyone has a care plan identifying their wishes at the time of their death. Putting in place a Care Homes for Older People Page 8 of 35 structured weekly programme of activities. Investigating the concerns raised by people who live at the home, and which have been raised in this report. Increasing the National Vocational Qualification (NVQ) training for staff. Making sure all staff have a minimum of six formal supervision sessions per year. 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 35 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 35 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. People have access to detailed information about the services on offer, they have contracts or a service agreement and they receive a comprehensive assessment, which allows them to make an informed decision about whether the home can meet their needs. Evidence: Both the statement of purpose and service user guide for the whole of the care home were seen during the inspection visit. These documents are in the process of being updated, and the content within both documents is good, and contains useful information about the care home. Both documents are currently available in large print format, and the acting manager said that Head office is in the process of producing a copy in an easy read format, on audio tape, Braille and on a DVD, although at the time of the inspection these were not yet available. The information available would allow people living at the care home, and those who might wish to in the future, to make an informed choice about living at Rufford Care Centre. Care Homes for Older People Page 11 of 35 Evidence: Discussions with three older people who live at the care home showed that they had been given copies of the service user guide, and copies were seen in peoples bedrooms. The foyer of the home also has copies of the last inspection report on display. The care home has a web page, which is part of Mimosa Cares website, and which is located at: www.mimosahealthcare.com. This web site also has a link to the Care Quality Commissions web site, where Rufford Care Centres past inspection reports can be seen. As part of the case tracking process a number of care files were seen for younger people who live at the care home. Some of these contained an agreement from Social Services to fund their placement, and a copy of the terms and conditions of residence. However not all of the files had this documentation, and in their AQAA, the home said: 5 people who are privately funded have a written contract, and 26 people whose care is funded by a council or health trust, have a copy of the agreement specifying the arrangements. The acting manager said that contracts and terms and conditions of residence are in the process of being introduced for everyone who lives at the care home. We looked at the care records of two people living in the Clumber Unit for younger adults with a physical disability and from looking at these records we were able to confirm that staff had received detailed information about them before they came to live at the home. Records included a physical and social assessment document, although the amount of information about social needs was not extensive in either of the records we looked at. However one contained a My Plan document which gave a useful outline description of the individual involved and a separate brief life history. Each persons records also contained a good range of assessments of risk in their lives, and a Personal Health Plan. Documents were completed by senior staff from the home as well as professionals from relevant health and social care services and further assessments were completed after the person had moved in to live at the home. There was no documentation completed that relates to peoples ability to make decisions for themselves under the Mental Capacity Act (2005); this will help make sure that peoples interests are fully protected. We were told that the style of documentation had been developed during the past year and, although all the key requirements had been covered, the style of all care records were staff centred rather than person centred. Rufford Care centre does not provide intermediate care, and therefore this National minimum Standard was not assessed. Care Homes for Older People Page 12 of 35 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some individuals are potentially at risk from not having care plans and risk assessments in place to record crucial information, and to direct staff in best practice to keep people safe. Evidence: Four files were seen in the older persons area of the care home. Care plans had mostly been written in the first person, which is good practice, however a number of the care plans had information missing, or forms that had been left blank. One individual had come to live at the care home a month previously, but there were no care plans in place, and most of the documentation within the file was blank. The care file states that information should be recorded within 72 hours of the person moving into the home. In their AQAA they said: On receipt of pre admission assessments, information from resident/family individual care plans are implemented within 48hrs of admission. There was evidence of care plans being reviewed, however there was a great deal of repetition, and little detail or substance in the evaluations, and a number of examples of gaps, with the National Minimum standard of a monthly review not being met. From their AQAA: Care plans are evaluated monthly or as when required. Care Homes for Older People Page 13 of 35 Evidence: The care plans all had a Memory diary in place which were very good, however none of these documents had been completed. Several files identified areas of need, for example the person being at risk of falls, or having nutritional needs, but there were no care plan or risk assessments in place to support those identified needs. Some of the files that were seen in the older persons areas of the home contained health related care plans. The plans included information relating to health care professionals such as visits to the doctor, or by the nurse, and any hospital visits. However for some individuals, there was clear evidence of health care needs being identified in the needs assessments or risk assessments in the file, or through one of the monitoring tools, such as the nutritional assessment, but no specific care plan or risk assessment in place to meet that identified need. In their AQAA they said: Care plans have a specific format to include risk assessments eg moving and handling, nutrition, mental health, medication. Plus: All primary and secondary healthcare is accessible to the residents and is fully recorded, risk assessments are completed, for healthcare and also where the choices of residents increased risk, such as going to the local town etc. Several care files were seen where this information was missing. In the youger adults area of the home, we looked at the care records of two people. They each had a personal care plan, mainly for use by staff but which was very detailed and individual to the person concerned. There were links to risk management plans that made sure all staff were working in consistent ways but there were no documents that carried any reference to peoples ability to make decisions for themselves under the Mental Capacity Act, as mentioned previously. We spoke to a number people in the younger persons unit throughout the inspection and, they were generally relaxed and happy in the way they presented themselves. The majority were aged in excess of fifty years and most people we spoke to told us they were content with their lives. However two people told us about constant dissatisfaction with standards of care and support they received and how they seemed to have litte influence about the way things were arranged. They told us that I am stuck with the routine that staff can offer me; its all about the satffing available to us, and that theres not a lot of room for variation, things can get very institutionalised, avenues for change seem to not be open, although Ive just found out about the Advocacy Alliance. Weve had no residents meetings recently so Ive given up giving my opinion. Care records in the younger persons area of the home indicated how people require personal care, support or prompting with self care, and all of the records we looked at indicated high levels being required. Most people on the unit require two staff in Care Homes for Older People Page 14 of 35 Evidence: attendance for personal care needs and this was confirmed by all of the people we spoke to, who were also all wheelchair users. The people we spoke to in the younger adults area desribed how staff were careful to respect their dignity and privacy and how personal care was always carried out behind closed doors. Each bedroom door has a written notice that is used to indicate when this activity is taking place. Whilst some people said that staff always responded to their buzzer when they requested help, one person was particularly strong in their observations about the timing of staff support to help her, particularly with her morning routine when she gets up for the day. She told us that I would prefer to get up much earlier but today was a late one, which means its only a couple of hours in my chair before I have to get on my bed again after lunch. I am stuck with the routine that staff can offer. Disability makes people very demanding and sensitive; for those that are waiting, fifteen minutes can seem like an eternity. All parts of Rufford Care Centre are in the process of changing from Boots to Lloyds Pharmacy for the provision of their medication. As a result not all of the new documentation had been completed, although the imprortant information was available on the old Boots documentation and was due to be transferred. An inspection of the medication systems showed that medication is handled safely. Administration records were seen and found to be complete, with no obvious errors or omissions. The records relating to an individual who self-medicates were seen, together with the storage facilities. All aspects of the medication procedures for checking medication in and out of the building showed a clear audit trail for medication, and indicated that people living at the care home were safe. Discussions with the individual who self medicates, showed that they were happy with the arrangements, and felt well supported by the staff. Discussions with several people, identified that the night staff started getting people up at 05:30 am so that when the day staff came on duty there were significant numbers of people up and dressed, and ready for the day. This issue was also raised in a telephone call to the Commission from a relative in May 2009, and was discussed with the acting manager who said that she would look into this issue, as it was not compatable with the homes stance on dignity and respect. Observation of the staff working with people on the day of the inspection visit showed that the staff treated people well. This included observing staff knocking on peoples doors before entering, and speaking in a respectful manner. In their AQAA they said: Care plans are written and shared to support and safeguard residents with privacy, dignity and gender in mind. Care Homes for Older People Page 15 of 35 Evidence: We carried out a Short Observational Framework for Inspection (a SOFI) during this inspection visit. This is where an inspector spent two hours, observing the interactions betwen staff and the people living at the home. The SOFI did not raise any major concerns about the quality of care that individuals are receiving in the older persons area, with good staff interaction and activities observed. Each persons file had a form for recording different aspects of the individuals wishes at the end of their life. Including burial or cremation, undertaker etc. However in the four files that were seen in the older persons area, each of the forms was blank with no information recorded. In their AQAA they said: End of life issues are addressed taking into account culture and diversity needs. Care Homes for Older People Page 16 of 35 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. Some people living at this care home are not offered choices, and their lifestyle suffers as a direct result. Evidence: There are a number of activity co-ordinators working at the home in different areas. Observations of the one in the old persons area identified that there was a mixture of group activities and individual one to one sessions. During the inspection visit there was an activity arranged around a horse race, with lively discussion among the people involved. Earlier there was a game of cards and when asked we were told: We have a race afternoon today. We played Monopoly the other day laughed so much really enjoyed it. In their AQAA they said: Activities are undertaken across the home 7 days a week. Residents are stimulated by either being encouraged to take part in the daily activities programme or getting involved in the lively surroundings of the home. In the younger adults area of the home: In the AQAA we were told about the actvities that take place within the home seven days a week and the documents that are in use to support an individulaised approach to work and play. We were told that menus are discussed at residents meetings and suggestions are forwarded to the cooks. Care Homes for Older People Page 17 of 35 Evidence: Discussion with staff and observations made during the visit confirmed that the daily routines of the home continue to be flexible and people were seen within the unit during the inspection, by themselves or with staff. We were told that there is an activities organiser employed within the unit but he was not on duty on the day of the inspection. We looked at the written records that he maintained for each individual and most people had enjoyed a series of one to one activities within or outside the unit that included crafts, visits to local shops, leisure centre, pubs and the park and also a visit to the local church. We did not see any evidence that these activities were taking place on a structured individual daily or weekly plan and nothing structured took place in the younger persons area on the day of the inspection. People were seen to be mostly in their rooms, with one or two in the communal areas or private areas with staff. The people we spoke to confirmed that most of their daily lives centred around the unit and, although they commented on the positive impact of the activities organiser most, but not all, said: that there was not enough to do, I would want to be able to go out more but theres not enough staff. and I rely on my family to take me out. However another said that I am well looked after and content here. I do what I want in the way of routines and activities and Im not bothered about having more outings. Unfortunately no relatives were spoken with during this inspection visit, so it was not possible to gain their views directly. Comments from the younger adults area included: People told us that vistors and family were free to come into the home and a number have very regular contacts. One of the staff members said that the keyworker system works better now and it encourages us to have some one to one time to talk and see if there is anything they need. One of the people living at the home suppported this view and said that I get on well with my keyworker, shes somebody to talk to and she organises my clothes shopping. We saw some evidence within the home that a local advocacy service existed but none that indicated any involvement with anybody living in the unit. In the older persons area one person said: I used to go to church but dont now as I cant get there, also used to be in the choir and I used to paint I cant do any of these things now I am here. One gentleman was an artist, and showed us paintings he had done, on the wall of his room. He said: I like to paint, but I dont get the chance any more. Staff were observed to see how well they interacted with the people who live at the home, and whether they were offering choices. These observations showed examples of choice being offered, particularly with regard to refreshments, food and activities. Care Homes for Older People Page 18 of 35 Evidence: Staff in the kitchen demonstrated how choices were offered and recorded at meal times, with people being asked on an individual basis in the morning, what they would like for lunch. Observations of staff arranging and carrying out activities during the inspection visit, showed that individual choice was taken into account. However, as already identified some people are being got out of bed at 05:30 am with no regard to personal choice. The central kitchen is located in the basement, and provides the main meals to all areas of the home. Although there are a number of kitchenettes where people can make drinks and snacks, and breakfast should they opt of cereal or toast rather than a full cooked breakfast. On the day of this inspection visit there was a good choice of meal on offer. The chef was aware of important information relating to medical conditions such as diabetes, and individual likes and dislikes had also been recorded. The food was well presented, and the dining rooms were attractively laid out for people, including the menu being in a holder on each individual table, and there is also a pictorial menu available to help people who have difficulty with written English or memory. The design of the building has meant a number of small dining areas scattered throughout the building rather than a large central canteen. Several people were spoken with about the food, with a mixture of responses from: I like the food, its very nice. I think the food is very good. and The food can be monotonous there is a choice and I can have a jacket potato instead. A review of the care plans in the older persons area showed that most people had a nutritional assessment, however there were a number of instances where that assessment raised concerns, but there was no care plan to address those concerns. The home has a coloured placemat scheme, which will discreetly tell staff if a person needs help with eating their food. In the younger persons area: Our observations about the catering arrangements in the unit were limited to a brief observation of lunch being served and those that needed help were seen to be supported in sensitive and careful ways. We also saw a clear choice of meals being offerred on the written lunch menu, placed on each table. The feedback received was generally positive about the meals provided and people told us that the food is marvellous, and that the food is fine, its how I like it. However another person told us that she prefers her main meal of the day to be in the evening so she supplements the teatime meal with her own food, although she did tell us that the meals served by the home have improved, and we get proper food now. Care Homes for Older People Page 19 of 35 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the care home and their relatives are not always confident that their complaints will be taken seriously and dealt with. Evidence: Rufford Care Centre have received eighteen complaints since the last key inspection in March 2009. In addition the Commission have received three. A review of the complaints showed that they had been dealt with in line with the homes complaints procedure, which is on display in the foyer, and also forms part of the service user guide. The complaints received by the Commission were discussed with the acting manager who provided further information, and updated the information available to the Inspectors. Three people who live at the home were spoken with, and they said: We did have a complaint afternoon when the activity organiser sat and went through any issues we had. The activity organiser took the minutes said they found that the staff are not always obliging they dont always get a cup of tea and they were told all they had to do was ask, they have done this and the staff have told them that as it is so close to tea time they could wait. Tea arrived at 4:10 pm on day of visit tea time is 4:30 pm all the ladies were complaining about this. Never been told how to complain but if had anything would speak to someone. One lady reported that sometimes they got up too early, between 5:30 am and 5:50 am. We dont want to, but we are not always given a choice. Two other ladies agreed that this happens. This issue has been raised elswhere within this report, and will be looked in to by the acting manager. Care Homes for Older People Page 20 of 35 Evidence: In their AQAA the home said: Protection of residents are of paramount importance and any complaints are immediately and effectively dealt with through the companys complaints procedure. A review of the staff training records in relation to safeguarding adults, showed that forty out of eighty seven care staff had undertaken this training in the last twelve months. The training was delivered throughout 2009 and copies of certificates were seen in staff files. This training is aimed at staff, to offer people greater protection against abusive practice, and to ensure staff understand the correct policy and procedure to follow. Evidence was seen that further training courses have been booked for 2010, and there are plans for the remaining 47 care staff to attend. Three members of staff were asked about safeguarding adults training and they said they were aware of the issues, and had undertaken this training. The acting manager said that Rufford Care Centre have not had made any safeguarding adults referrals since the last key inspection, although this information was missing from the AQAA. Care Homes for Older People Page 21 of 35 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 safe, clean, well maintained and comfortable home, with their personal possessions around them, this means that people are living in homely surroundings that meet their needs. Evidence: A partial tour of the building showed that Rufford Care Centre is a large care home, with 100 individual bedrooms. However apart from the long corridors it does not have the feel of a large institution. This is due to the design of the building, where small lounges and dining rooms have been used rather than big cafeteria style dining areas, and large communal sitting areas. The older persons area of the home is well furnished, and while some areas are getting ready for recoration, with torn wallpaper, and scuffed paintwork, the overall impression is of a comfortable and well maintained care home. The carpets are generally in a good condition, and there were no obvious safety issues observed. The dining room and laundry are located in a huge basement, well away from the living areas. Bathrooms were well equipped with specialist bathing equipment, providing a number of options from bathing to showering. In the younger persons area of the home: We made a brief tour of the building with one of the people who live at the home and the acting manager. We found the unit clean, tidy and offering comfortable accommodation, which people occupy in single rooms with ensuite facilities. Good standards of decoration have been maintained and Care Homes for Older People Page 22 of 35 Evidence: all the bedrooms we looked at are very much to each occupants individual choice of style and furnishing. The rooms are personalised with pictures, personal mementoes and photographs and one person showed us her tropical fishtank which she had installed. The laundry for the unit is centrally located and offers a service to the whole home. (I did not see this). People living on the unit do not take any responsibility for cleaning or laundry activities. Standards of cleanliness and hygiene around the home were good and clothes were clean and appropriate. We were told by the people living at the home that My room is fine and Ive got everything I need. I watch TV by myself if I want and all the mobility equipment is working OK. However two of the people we spoke to told us that Shower equipment is in short supply; the trolley broke last year and there was a delay in getting it fixed and Shower equipment is not very good; one size fits all. Staff were seen cleaning in different parts of the building during this inspection visit, and discussions with staff showed that there were systems in place for cleaning, and that the care home had a good supply of cleaning materials. The building was found to be clean, and smelt fresh. In relation to cleaning they said in their AQAA: We have: A very homely environment, structured maintenance and health and safety records, maintenance staff who are responsible for general upkeep of the home and grounds, environment risk assessments, housekeeper and good numbers of ancillary staff, no smoking policy. Comments received from people living in the older persons area included: The home is spotlessly clean. Care Homes for Older People Page 23 of 35 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are policies and procedures in place for recruitment and training of staff. However these policies have not always been followed, and the staff training regime does not currently meet the National Minimum Standard, which potentially leaves people at risk. change judgement Evidence: Given its large size the home employs a substantial group of staff in all categories and with recent levels of vacancy has had to rely on the use of agency staff to cover personal and nursing care. Within the unit staff told us that things have improved with agency staff and we now use regulars who know the unit and the people who live there, and offer consistency of care. The target for staff on duty within the unit is for five carers and a nurse throughout the day shifts, although there were four on duty for the morning of the inspection. The unit manager is extra to these numbers and was there for the early day shift. The staff we spoke to told us that staffing levels were frequently difficult due to recent levels of vacancy but that the day shifts have been sorted out now with new staff due to start soon. The people living at the home echoed staff comments and we were told that they operate with the fewest possible members of staff, theres never any extra staff to cope with the range of needs, and that most people need two staff to help them and when four are on there is no Care Homes for Older People Page 24 of 35 Evidence: flexibility, the levels of staff affect my daily routine, particularly the gender issue if male staff are on duty and staff are not always available when I want them. The care industry considers National Vocational Qualifications (NVQ) to level II in care to be the basic qualification for staff working in residential care. A review of the staff training records showed that currently there are eighty seven care staff at Rufford Care Centre (identified in the AQAA), of whom there are six staff with NVQ level II qualifications. In addition there are several qualified nurses working at the care home in the nursing areas. On the day of the inspection a member of staff from the Mimosas training department was on site, signing staff up for NVQ courses and apprenticeships. The National Minimum Standard says that 50 of staff should be qualified to a minimum of NVQ level II in care. We looked at the recruitment file of three of the staff working in the home, two of whom had been recruited since the last inspection and one who had been at the home for some time. The contents of the former were all in order and indicated the required checks and references being made in a systematic way. However there were a number of significant gaps in the file of the latter which would indicate that staff recruited under past management regimes may potentially be unsafe and that people working at the home may not all be suitable. We were told that the homes link resident who lives in the unit is actively involved with the homes recruitment processes. Issues related to the recruitment of staff, previously identified by the management of the home, have been dealt with. The staff training records showed that the care home does have a training plan for its staff. The training records showed that staff were receiving the training to help them to do their jobs, and this includes the mandatory training in areas such as moving & handling, fire safety and health & safety. Discussions with three staff members provided evidence of the training courses staff had attended, together with certificates seen in staff files. In their AQAA they said: We promote and highlight the need for staff training. Staff receive a skills for care induction. Mimosa training department, which deliver training in NVQ and key skills. In the AQAA we were also told about the the need for staff training to be highlighted and about the recruitment, induction and supervision of new staff. Care Homes for Older People Page 25 of 35 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management arrangements of the home are not robust, and this is affecting the wellbeing of the people living there. There are systems in place to protect the heath & safety of people living and working at the home. Evidence: Rufford Care Centre does not currently have a Registered Manager. At the time of the inspection visit Gillian Lindley is the acting manager, and she planning to shortly begin the process of being registered with the Commission. Gillian has been the acting manager since August 2009. The AQAA was received within the time frame asked for. The AQAA provided some useful information, on which we were able to base judgements, although there were some gaps, and some of the information/ statements were found to be incorrect. In addition information relating to the policies and procedures showed that the majority had not been reviewed since 2006 or 2007, and are overdue to be updated/ reviewed. Information relating to the number of deaths at the home during 2009, were not Care Homes for Older People Page 26 of 35 Evidence: matched by a corresponding number of Regulation 37 notifications to the Commission. Under Care Homes Regulations any registered care home is legally obliged to inform the Commisssion of any deaths, illness or other events (which affect the wellbeing of service users). In the AQAA the home identified 32 deaths during 2009, of which the Commission were notified of two. The Commission only received nine Notifications from the care home during the whole of 2009. There is not currently a recognised quality assurance system in place, although discussions with the manager outlined plans to develop the existing practice which rely on questionnaires being filled in by people who live at the care home, relatives and visitors, and to introduce a recognised quality assurance system. Copies of questionnaires were seen, and they are available in the foyer. The results are evaluated at head office, and then discussed with the manager. There are meetings for the people who live at the home, and copies of minutes of meetings were seen. Regulation 26 visits, these are monthly audits by a representative of the owners management team are taking place, with copies of reports seen. Rufford Care Centre has a system for peoples small cash needs. This is operated on behalf of some people by the staff (dependent on individual choice and their ability to manage the money, or relatives involvement). Four peoples finances were checked at random. All of the cash tallied with the records, and receipts were seen, which enabled a clear audit trail of the individuals financial expenditure to be followed. Comments received from three people living at the care home included: I look after my own money. My daughter looks after my money. My relatives bring money in for me when I need it, it is kept in the office. Rufford Care Centre has a formal staff supervision system in place, in which staff receive supervision, either with the manager or with one of the other senior members of staff. This is usually in a one to one meeting. Formal supervision offers staff support and guidance in carrying out their work, and is seen as an essential management tool in residential care. The records showed that the National Minimum Standard of six formal supervisions sessions per year for every member of staff are not currently being achieved. Several members of staff were asked about formal supervision, and they said they felt well supported, with the following comments received: Things are much better with the new manager, we are being supported properly now. We have a positive oulook now and most people are upbeat about working at the home. The home is on the way up with the new manager. Good morale is present and the manager is working hard to improve things and deal with poor practice. Comments received from a person living at the home were also positive: The manager is one of the best weve had and I work alongside her in my role as link resident. In their Care Homes for Older People Page 27 of 35 Evidence: AQAA they said: We have: Staff one-to-one supervisions, giving staff opportunities to air their views on any concerns/worries, training requirements. Yearly appraisals, and regular staff meetings, with an open door policy giving staff access to the manager at any time. A range of different health & safety records were seen, including the fire safety records, water temperature checks and the Control of Substances Hazardous to Health (COSHH) records, all were found to be correct and up-to-date. Evidence was seen that routine health & safety checks are being carried out, and the staff training records showed that staff were receiving relevant training in health & safety related issues. in their AQAA the care home identified the majority of the systems, such as the fire systems, the gas supply and the electrics, had been serviced and maintained within the last twelve months, copies of the relevent documentation was also seen to support the statements made in the AQAA. Care Homes for Older People Page 28 of 35 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 29 of 35 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 7 17 The registered person must ensure that documentation within the care plans is complete and up-to-date. Incomplete and out-of-date records and documentation will potentially leave people at risk. 31/03/2010 2 7 15 The registered person must ensure that every person living at the care home has a written care plan to detail how their needs will be met. People will be potentially at risk if there is no care plan to instruct the staff in how to meet their needs. 31/03/2010 3 7 13 The registered person must ensure that any identified risks to a persons health or welfare have a risk assessment in place to instruct staff how to minimise that risk. 31/05/2010 Care Homes for Older People Page 30 of 35 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 People who live at the care home and who have identified risks to their health and welfare will potentially be at a higher risk if no risk assessment has been completed. 4 10 12 The registered person must ensure that care practices within the care home do not compromise peoples dignity. Quality care cannot be delivered without consideration of peoples dignity and respect. To ignore these concepts leaves people potentially at serious risk, and getting people up and out of bed at 05:30 in the morning demonstrates a lack of dignity and respect. 5 14 12 The registered person must ensure that people living at the care home are able to make decisions with regard to the care they are receiving. Peoples privacy and dignity will be compromised if they are not able to make choices and decisions about their own care. 31/03/2010 31/03/2010 Care Homes for Older People Page 31 of 35 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 6 27 18 The registered person must 31/05/2010 carry out a review of staffing levels to ensure that there are sufficient numbers of staff on duty to meet peoples needs. Insufficient numbers of staff on duty will leave people potentially at risk. 7 29 18 The registered person must ensure that all staff records indicate that the documents and checks required under Schedule 2 of the Regulations have been obtained. Namely a written application form, a Criminal Records Bureau check, and two written references. This is to ensure that the health welfare and safety of people living at the home are protected. 31/05/2010 8 30 18 All staff must receive 31/08/2010 training in safeguarding adults that helps them to fully protect the rights of the individuals in their care and to safeguard them from harm. If staff have not been adequately or appropriately trained to meet peoples Care Homes for Older People Page 32 of 35 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 needs, this will potentially leave those people at risk. 9 31 37 person The registered manager must inform the Commission of any death, illness or other event which affects the wellbeing of people living at the home. This is to ensure an open working environment, and to offer protection to the people who live at the care home. 10 31 8 The acting manager must submit an application to the Commission to be the registered manager. It is a legal requirement under the terms of the Care Standards Act (2000) that a registered manager is appointed to manager a care home. 11 33 24 The registered person must introduce a recognised quality assurance system. This is to ensure that the quality of the home is being monitored and improved. 31/07/2010 31/05/2010 31/03/2010 Care Homes for Older People Page 33 of 35 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 2 Every person who lives at the care home should have a contract or a copy of the terms and conditions of residence, with a copy kept on file at the care home. Mental capacity assessments in line with the Mental Capacity Act (2005) should be carried out for all people at the care home, where there is an issue in relation to the individuals capacity. If an assessment identifies an area of need, there should be a care plan in place to instruct staff how to meet that need. Care plans in the older persons area of the home should be reviewed on a monthly basis, with a written evaluation of the care plan available for inspection. Care planning and support documentation should be developed in ways that are person centred and which demonstrate a more idividualised approach to planning and delivering care. Every person living at the care home should have an end of life care plan, identifying the wishes and requirements at the trime of their death. People should be supported to develop a structured weekly life plan that helps them maximise their independence and gives them opportunities for enjoying a broader range of experiences. People living at the care home should be able to make decisions with regard to the care they are receiving, and receive care and support to facilitate those decisions. The concerns raised by people during the inspection visit should be investigated by the homes management, and addressed. A programme of training for care staff in National Vocational Qualifications (NVQ) should aim to meet the National Minimum Standard of 50 of the staff team, suitably qualified to NVQ level II. All staff should receive a minimum of six formal supervision sessions per year, in line with the National Minimum Standards. 2 3 3 7 4 7 5 7 6 11 7 12 8 14 9 16 10 28 11 36 Care Homes for Older People Page 34 of 35 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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