Care Home: Rugby Care Centre

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What the care home does well The home has warm and friendly atmosphere. The people living at the home have good relationships with staff and they are relaxed with them. Staff have a good understanding of working with people with dementia and are skilled at encouraging their independence. People have good access to local General Practitioners and specialist healthcare when required. Visitors are made welcome and people are encouraged to maintain contact with family and friends. People are regularly consulted and involved in the day to day running of the home. The home is well managed and people living at the home benefit from this. What has improved since the last inspection? The manager is now notifying the commission of any incidents as required by the regulations. Equipment is not stored in the corridors and more storage space has been identified in the home. An activities co-ordinator has been employed so that people have the opportunity to join in group activities or have one to one activities. Fire doors are not wedged open.The boiler has been repaired and a majority of the room temperatures are now maintained at a comfortable level. The schedule of accidents now reflects the accident forms completed. Daily menus are now placed on the table and displayed in the dining room so people can be reminded of the day`s meals. The home is now fully staffed after a period of using regular agency staff. What the care home could do better: They need to make sure that any assessments completed with people are accurate. Good practice recommendations have been made about updating the assessment format; updating care plans, as people`s needs change and reviewing the use of care plan monitoring records. `As required` medication plans should be written, additional staff support should be provided at lunchtimes and staff should have an understanding of the Mental Capacity Act. CARE HOMES FOR OLDER PEOPLE Rugby Care Centre 53 Clifton Road Rugby Warwickshire CV21 3QE Lead Inspector Jo Johnson Key Unannounced Inspection 4th April 2008 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Rugby Care Centre DS0000004292.V362533.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Rugby Care Centre DS0000004292.V362533.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Rugby Care Centre Address 53 Clifton Road Rugby Warwickshire CV21 3QE Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01788 542353 01788 567941 rugby@ashbourne.co.uk Exceler Healthcare Services Limited Karin Mary Houghton Care Home 29 Category(ies) of Dementia (9), Old age, not falling within any registration, with number other category (20) of places Rugby Care Centre DS0000004292.V362533.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 17th April 2007 Brief Description of the Service: Rugby Care Centre is an established care home providing personal care for up to 29 residents, 9 beds form part of the registered dementia care unit. The home is a detached dwelling near to the town centre of Rugby, and is placed near to good bus and train services. The main shopping centre is only a few minutes walk from the home. Rugby Care Centre admits service users for respite and long term care. The care staff are supported by the benefits of a large well-established organisation. Accommodation is mainly single room accommodation over two floors, but the majority of rooms available on the ground floor form part of the dementia care unit. Two shared rooms are available on the top floor. The home is a ‘non smoking’ environment. Information about the home is available in the home’s ‘Statement of Purpose’ and the ‘Service Users Guide’. Rugby Care Centre DS0000004292.V362533.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for people who live at the home and their views of the service provided. This process considers the home’s capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provisions that need further development. There was a random inspection undertaken in December 2007 following an adult protection concern raised by the local authority. The findings of this inspection are available on request. No additional areas of concern were identified at this inspection. The manager supplied the commission with an AQAA (Annual Quality Assurance Assessment). Information from this has been used to make judgements about the service, and have been included in this report. Surveys were sent to ten of the people living at the home and ten staff. Four surveys were returned from people living at the home and all were positive about living there. Two staff surveys were returned and showed that they do not have any concerns about working at the home. The findings of the surveys are reflected through out the report. This was the home’s first key inspection of 2008/2009. The inspection visit was unannounced (we did not let the home know that we were coming) and took place on 4th April between 9am and 5pm. The inspection involved: • • • Observations of and talking with the people who live at the home and the staff, deputy manager and manager. Observation of working practices and of the interaction between individuals and staff. Four people were identified for close examination by reading their, care plan, risk assessments, daily records and other relevant information. This is part of a process known as ‘case tracking’, where evidence is matched to outcomes for people. Rugby Care Centre DS0000004292.V362533.R01.S.doc Version 5.2 Page 6 • A tour of the environment was undertaken, and home records were sampled, including staff training and recruitment, health and safety, and staff rotas. We, the commission would like to thank the people who live at the home, manager, deputy manager and staff for their hospitality and cooperation during the inspection visit. What the service does well: What has improved since the last inspection? The manager is now notifying the commission of any incidents as required by the regulations. Equipment is not stored in the corridors and more storage space has been identified in the home. An activities co-ordinator has been employed so that people have the opportunity to join in group activities or have one to one activities. Fire doors are not wedged open. Rugby Care Centre DS0000004292.V362533.R01.S.doc Version 5.2 Page 7 The boiler has been repaired and a majority of the room temperatures are now maintained at a comfortable level. The schedule of accidents now reflects the accident forms completed. Daily menus are now placed on the table and displayed in the dining room so people can be reminded of the day’s meals. The home is now fully staffed after a period of using regular agency staff. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Rugby Care Centre DS0000004292.V362533.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Rugby Care Centre DS0000004292.V362533.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3 Quality in this outcome area is adequate. People’s basic needs are assessed so that they can be sure the home can meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager told us that she is reviewing the organisation’s service user guide and making it more personalised to the Rugby Care Centre. People and visitors spoken with said that either they or their relatives visited the home before making a decision about moving in. One relative said they had visited many homes and had moved her mother from another home into Rugby Care centre, as she was impressed with the atmosphere and staff. Another person said, “I came to have a look with my daughter I was at Rugby Care Centre DS0000004292.V362533.R01.S.doc Version 5.2 Page 10 another home, I didn’t want to go back home…the staff are friendly and I have made a friend.” One person commented on their survey “I came to the home a few times before I moved in. I really enjoy it and knew it was the right place for me.” There was evidence on all files read that information is sought by the home from care management assessments, and where appropriate, other health professionals. The manager or deputy undertakes a pre admission assessment before determining whether they can meet someone’s needs. A fuller assessment, risk assessments and a social history assessment are completed with people as soon as they move in. From this a care plan is developed. The wording in the assessment format assumes that all people have a ‘marital’ status. The use of the term ‘partner’ should be considered so that people’s individual important relationships are acknowledged. One of the people’s information relating to their diabetes was not clear in their assessment and care plan. In the initial assessment the information is that the person is a diet controlled diabetic. In another section, it refers to the diabetes being diet and tablet controlled. On admission, a body map of any bruises or marks was made and this refers to bruising from ‘insulin injections’. This information was incorrect and confusing. Following discussion with the manager the staff member who completed this chart assumed that the injection site bruises were due to insulin without clarifying what the injections were. This same person’s assessment and personal profile and history were incomplete. It is important that any initial assessment information is correct so that any care plan that is developed relates to the individual’s needs so that staff can care for them properly. People, families spoken with, and records seen told us that they had enough information about the home and have a contract following the trial period. Rugby Care Centre DS0000004292.V362533.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is good The health and personal care that people receive is based on their individual needs. The principles if respect, dignity and privacy are put into practice. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Each person had a care plan, daily records and monitoring records. Care plans were generally based on information gained during the initial care needs assessment and were developed as staff got to know the individuals. All of the people had tissue viability, nutritional, falls and moving and handling risk assessments and management plans in place. The care plans were of a suitable quality and were easy to follow. However, as identified at the random inspection in December 2007, the plans had not been amended following the monthly monitoring reviews. For example, one Rugby Care Centre DS0000004292.V362533.R01.S.doc Version 5.2 Page 12 person’s nutritional plan and risk assessment referred to them eating a soft diet. From the daily records, discussion with their relative and what we observed the individual is now eating a normal diet. Another person’s assessment and care plan refers to them being weighed weekly following their admission in 2006. The nutritional risk assessments and the monthly weights show that this person is no longer losing weight. Again, the care plan has not been amended to reflect this change. There is standard organisational format for the care plans and this includes a ‘weekly summary’ section. For all of the people case tracked these had not been completed since the end of January 2008 or in one case not at all. This is in addition to the monthly evaluation that takes place. As these have not been routinely completed, the value of them should be reviewed. People living in the home looked well cared for and were clean, their hair had been combed and nails were trimmed and clean. They were well presented and wore clothes that were suited to the time of year. Garments were clean and well maintained. Relatives and people spoken with said that staff always take care to make sure people are well dressed and their appearance is cared for. Care staff spoken with said that care plans were clear and easy to follow. They had a good understanding of people’s needs and how to meet them. Peoples’ preference of gender of staff is identified on their assessment. However, this not then transferred on to their care plan. Two people spoken with confirmed that their choice of gender of staff was respected. They said, “I can have bath when I want one, I only have lady for bath I wouldn’t like a man” and “I only have ladies help me with a bath, I can do everything else myself”. Staff respected people’s privacy and dignity, by knocking on their doors and offering personal care discreetly and in private. Staff observed were very skilful and discreet in encouraging people with dementia to accept personal care. Peoples’ surveys show that staff treat them well and that carers listen and act on what they say. Staff observed had good relationships with the people living at the home and were patient and encouraging. People with dementia freely approached staff and staff gave them reassurance when needed. Staff spoken with had a good understanding of recognising people as individuals, respecting their privacy and dignity and they were knowledgeable about them as a person. The manager has identified and is prioritising life Rugby Care Centre DS0000004292.V362533.R01.S.doc Version 5.2 Page 13 history work for people with dementia. This means that staff will have an even greater understanding of the individuals they care for. Discussion with people living at the home, relatives, the manager, staff, observation of care plans and daily records showed that people living in the home have access to other health professionals such as GP, dietician, dentist and specialist consultants and chiropodist. The medication systems and administration at the home are generally well managed. Medication policies and procedures are safe, with medication being stored safely, and labelled correctly. Medication administration records seen for the four people were completed correctly. However, one person has a PRN (as required) medication. There is not an ‘as required’ protocol in place that specifies specify under what circumstances it is to be given, how long between doses and what is the maximum dose in 24 hours. ‘As required’ medication plans should be written. The prescribing practitioner or health professional should approve these medication plans where possible. This is so that staff know how and when to safely administer as and when medication. Rugby Care Centre DS0000004292.V362533.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is good People living in the home are supported to maintain their independence, contact with important others and lifestyle, which enhances their quality of life. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People spoken with said that their visitors were made to feel welcome whenever they visited. One person said, “My visitors can come whenever they want and they are made to feel welcome, my son likes to come late evening and that’s ok”. Another person said “staff always check whether I want to see visitors before letting them come up”. During the inspection there were a number of visitors and those spoken with confirmed that they are welcomed and that staff are approachable. Comments included “staff are friendly, welcoming and know my mum well” and “we come at different times and are always made to feel welcome”. Rugby Care Centre DS0000004292.V362533.R01.S.doc Version 5.2 Page 15 There is now an activities co-ordinator at the home and there is a regular daily programme of social activities. These are displayed on the main notice board of the home. There is a PAT (Pets as Therapy) dog that visits on a regular basis. The activities co-ordinator was on holiday on the day of inspection. Staff working in the dementia care unit were observed playing cards with people before lunch. People and relatives spoken with said that there were regular activities that people could join if they wanted to. One person said that they choose not join in group activities but has a one to one session with the activities worker and they go into town shopping and go of coffee. On the day of inspection there was a relatives and residents meeting. The manager facilitated the meeting and people from both the residential and dementia care units attended. People were given the opportunity to feedback their experience of living at the home and commented on the activities and the food provided. There was a relaxed and informal atmosphere. This is good practice and people spoken with said the manager always follows up on any issues raised. People spoken with and observed got up and spent their time how and where they chose. The kitchen was well stocked with a variety of fresh and long-life foodstuffs. The cook was knowledgeable about the diets of the people at the home and soft and diabetic diets are provided. People spoken with generally enjoyed the food and said there are always choices available. One person brought up at the residents meetings that they did not like some of the meals provided. From discussion with people and the manager, people choose their meals the day before. There are plans to introduce a photographic menu so people can make visual choices for their meals. A daily menu has been produced to go on each table so that people can be reminded of what they have chosen. We joined the people living on the dementia care unit for lunch. The care staff served the meal from the hot trolley and also assisted and encouraged people to eat. The staff did not have sufficient time to sit and eat with people as they were serving meals and looking after one person who was in bed. Staff were at all times sensitive and calm when supporting people but the time constraints meant that some people’s food was cold by the time staff got round to assisting them and staff did not have time to sit with people. From discussion with staff and the manager, member of the kitchen staff used to serve the meals so that care staff could spend the time supporting people in a relaxed atmosphere. The practice should be reintroduced. Rugby Care Centre DS0000004292.V362533.R01.S.doc Version 5.2 Page 16 Many people in the home had a cold and were feeling unwell. Staff in the dementia care were very proactive in encouraging people to drink plenty of both hot and cold drinks. Rugby Care Centre DS0000004292.V362533.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good Complaints procedures make sure that peoples, relatives and representatives concerns and complaints are listened to and acted upon. A staff team who have a good knowledge of how to respond to any suspicion of abuse and to keep people safe from harm support the people living at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: From discussion with the manager and information provided in the AQAA, there have been four complaints that have been investigated and resolved in the last 12 months. The records were seen for these complaints and they included the investigation and outcome. The commission has received one complaint since the last key inspection. The organisation appropriately investigated the complaint and the manager had already taken action to address the issues identified before the complaint was received. A ‘Comments Book’ is available in the reception area to give residents and their visitors the opportunity to record concerns or compliments in an informal way. Rugby Care Centre DS0000004292.V362533.R01.S.doc Version 5.2 Page 18 People spoken with and surveys tell us that they knew who to talk to if they were unhappy or needed to complain. Relatives spoken with know how to make a complaint about the home. One relative said, “ I’ve not needed to complain about anything, not like the last home mum was in…the staff are very approachable and we need anything we just ask them and they sort it out”. Staff have attended training in the Protection of Vulnerable Adults (POVA) so that they are aware of the different ways vulnerable people are at risk of abuse, and would know how to respond. Staff spoken with had a good understanding of how to recognise and report any allegations of abuse. One staff member was able to describe how they had used the ‘whistle blowing’ policy in their previous job to report an allegation of abuse. People with dementia were observed to be very relaxed with staff, gave them many smiles and were happy to approach them. This may indicate that they feel safe. Two people spoken with said that they feel safe at the home. One person said, “I don’t always feel safe with some of the residents who are confused, you can’t fault the staff they manage them well”. There has been one safeguarding referral made to the commission. This resulted in the random inspection in December 2007. The manager and staff had limited knowledge, understanding or the implications of the Mental Capacity Act, which was fully implemented on 1st October 2007. The manager and staff should have information and or training on the Mental Capacity Act. This is so they can understand the importance of the new legislation and the impact that it will have on the people living at the home who may have previously been assessed as not having capacity to make decisions about their lives. Rugby Care Centre DS0000004292.V362533.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 Quality in this outcome area is good The home is maintained and furnished so that people live in a homely, clean, comfortable environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home provides a relaxed, cosy and friendly atmosphere. Communal areas of the home are spacious, comfortable, light and airy. Armchairs are comfortable and clean. Carpets and the decoration are generally in good condition. Rugby Care Centre DS0000004292.V362533.R01.S.doc Version 5.2 Page 20 A tour of the home was undertaken with the manager. The manager went through the planned and ongoing maintenance and redecoration programme. Since the random inspection there has been ongoing work to address the fluctuating temperatures throughout the home. A number of rooms and the top of the landing that are still very warm. The organisation is looking into different solutions for these areas. During the inspection, there no doors propped open. There were no wheelchairs or other equipment stored in corridors or across fire exits as there had been at previous inspections. The surveys from people living at the home show that the home is fresh and clean. Personal rooms seen were nicely decorated and appropriately furnished. People are encouraged to bring their own belongings, personal items, and small pieces of furniture into the home. The home employs maintenance and gardening personnel. The home is well maintained, and the gardens are well kept and provide good additional outside space for people to use. From information provided in the AQAA and records seen during the inspection, there are good monitoring systems in place to make sure that the environment is safely maintained and managed. There is regular testing of water temperatures, servicing of equipment and systems. A tour of the kitchen and laundry found these to be tidy and clean. Washing machines are provided with sluicing programmes, and separate hand washing facilities are provided in both areas for staff, to minimise the risk of cross infection. Systems are in place to reduce the risk of infection. Disposable gloves, aprons and hand scrub are available and used by staff when handling soiled linen and when supporting people with personal care. Rugby Care Centre DS0000004292.V362533.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is good. The people living in the home are protected by robust recruitment practices and supported by a skilled, competent and well managed staff team. This judgement has been made using available evidence including a visit to this service. EVIDENCE: On the day of inspection there were 18 people living at the home. 10 people were living in the dementia care unit and 8 in the residential unit. Staff rotas seen show that staffing was as follows: 8am to 9pm = 4 care staff 9pm to 8am = 3 care staff In addition, there were enough laundry, catering, cleaning and maintenance staff to make sure that care staff did not spend time undertaking non-caring tasks. During the inspection, the staffing levels were adequate to meet the needs of people living at the home. Rugby Care Centre DS0000004292.V362533.R01.S.doc Version 5.2 Page 22 People, staff spoken with, and surveys show that there are enough staff to meet people’s needs and that staff are available when people want them. From discussion with the manager the staff team at the home has started to stabilised since the last inspection. There has been some turnover of staff but not as high as the previous year. The manager told us that the use of agency staff had been greatly reduced over the previous months as new staff had been recruited. Only regular agency staff are used. People spoken with said that there were some new staff and that they could not always remember their names. They commented that staff do wear name badges but that the writing is too small for them to see. Large print name badges should be produced so that people can easily read staff’s names. Four staff files were seen including the most recently recruited staff. The files were well organised. All files included evidence of CRB (Criminal Records Bureau) checks and PoVA (Protection of Vulnerable Adults) checks. From the AQAA (Annual Quality Assurance Assessment) completed by the manager, the training programme and discussions with staff there is a comprehensive training programme in place that focuses on mandatory training and the specific needs of the people living at the home. Staff spoken with said and surveys show that they are given training that is relevant to their role. Staff are given regular supervisions and these records were seen. The manager undertakes regular spot checks during the night. This is good practice. Rugby Care Centre DS0000004292.V362533.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 Quality in this outcome area is good. People benefit from living in a well run home. They are able to express their views of the service provision and know that their views will be listened to and acted upon. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager has been in post for two years and is now registered with the commission. She has completed the registered manager’s award and is an experienced home manager. Rugby Care Centre DS0000004292.V362533.R01.S.doc Version 5.2 Page 24 There were clear lines of accountability in the home and as well as the manager the senior team includes deputy manager, senior team leaders. There is a recently implemented line management structure in the housekeeping department. During the visit staff appeared confident in their roles, the home was relaxed and people appeared at ease and comfortable. Staff spoken with commented positively about the style of management and leadership from the manager, their job role and the people living at the home. Systems are in place to safeguard the finances of the residents in the home. Personal rooms have a lockable facility, but residents are also given the choice of using the home’s safe. The system used by the home produces a receipt and keeps a running total of funds available. All of the requirements from the previous inspections have been met. The manager is now notifying us of significant events under regulation 37. The schedule of accidents at the front of the accident book is now completed so that it can be cross-referenced. There is a quality assurance system in place from the organisation. The manager monitors and audits regulation 37 notifications, accidents and complaints on a monthly basis. People and their relatives are also encouraged to attend the regular meetings held in the home when they are asked their opinion of the service and encouraged to make suggestions. One of these meetings was observed during the inspection. Staff spoken with and records seen showed that staff are supervised and have had an annual appraisal. Information provided before the inspection, by the manager in the AQAA (Annual Quality Assurance Assessment) shows that relevant Health and Safety checks and maintenance are being carried out at the home. A number of Health and Safety records were checked, including the fire safety log. These records showed that health and safety matters are well managed. Rugby Care Centre DS0000004292.V362533.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 x 2 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 3 Rugby Care Centre DS0000004292.V362533.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP3 Regulation 14(1)(2) Requirement Accurate assessments must be completed for people. This is to make sure that peoples’ needs are identified and staff know how to care for them. Timescale for action 01/07/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP3 OP7 Good Practice Recommendations The use of the term ‘partner’ should be considered so that people’s individual important relationships are acknowledged. Care plans should be updated when a new or changed need is identified. Staff should not rely on new information recorded on the evaluation sheet. This should make sure staff have access to information about what they have to do to meet each person’s needs. 3 OP7 Review the use and value of the ‘weekly summary’ section of the care plans. DS0000004292.V362533.R01.S.doc Version 5.2 Page 27 Rugby Care Centre 4 OP10 This is so that any monitoring tools that are used have a value and can identify any changes required to plans. ‘As required’ medication plans should be written. The prescribing practitioner or health professional should approve these medication plans where possible. This is so that staff know how and when to safely administer as and when medication. 5 OP15 Additional support should be provided at mealtimes so that staff are able to sit with and support people to eat. This is to make sure that staff have the time to assist people whilst their food is hot and encourage them to eat in a relaxed informal atmosphere. The manager and staff should have information and or training on the Mental Capacity Act. This is so they can understand the importance of the new legislation and the impact that it will have on the people living at the home who may have previously been assessed as not having capacity to make decisions about their lives. 6 OP18 7 OP29 Large print name badges should be produced so that people can easily read staff’s names. Rugby Care Centre DS0000004292.V362533.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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