Care Home: Ruishton Court Nursing & Residential Home

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What the care home does well The home provides a statement of purpose / service user guide, which provides information for prospective people using the service. People told us that the staff were very kind and met their needs. Comments received included `My relative has always been very well cared for`. `The staff are always cheerful and helpful`. `The home always has the best interests of the residents`. `Friendly, helpful staff`, and `Dedicated staff and owner`. People are supported with their health care needs by having the access to the appropriate health care professionals. Visiting health care professions, who returned surveys, told us that they always found the home to be helpful. People told us that the food was of a consistently good standard and that they enjoyed the choice of meals and the dining experience. The home appeared to be maintained to have a good standard of hygiene with all areas appearing clean and free from odour. What has improved since the last inspection? One bathroom has been refurbished and a plan of maintenance is in place to repair/refurbish the remaining two bathrooms. Policies and procedures are being updated to provide staff with current best practice. The home now has in place a policy for challenging behavior. The home has employed a training coordinator to ensure that staff training is well managed. This manager has implemented a program of regular supervision for staff. Care plans now include peoples choices for night time routine and some include day time preferences for rising and retiring. What the care home could do better: The registered manager is required to ensure that people using the service or their relatives/representatives are recorded as agreeing to the plan of care in place. Care plans need to be further developed to ensure that they include all areas of assessed and changing need to ensure that staff know what care is to be given. The Registered Manager is required to undertake a regular audit of the medication Records to ensure that all records are well maintained and accurate and no gaps are evident. The provision of activities requires further development to promote a more person centered approach and ensure that all people using the service have access to some social and recreational activity on a regular basis. The complaints policy and the whistle blowing procedure were evident but lacked contact details for any external body to contact should a disclosure want to be made. The complaints policy also needs to be updated to include timescales of responses so that anybody wishing to make a complaint will know what response to expect. We are advised that copies stored as records did have the correct contact information. The home must continue its plan of refurbishment to ensure that all bathrooms are of a good standard and have no risk of cross infection. Cleaning solutions around the home must be stored correctly to ensure that there is no risk of accidental ingestion of substances which are hazardous to health. The registered manager must ensure that all recruitment checks are in place prior to the staff member starting work at the home to ensure that there is no risk to people using the service. The registered manager must also ensure that there are consistently sufficient levels of staff on duty to meet the dependancy levels of people using the service. The registered manager is recommended to ensure that 50% of staff have achieved a level 2 National Vocational Qualification in care as recommended by the National Minimum Standards. The Registered Manager is recommended to audit accident records monthly and use the information obtained to promote accident prevention. Key inspection report Care homes for older people Name: Address: Ruishton Court Nursing & Residential Home Ruishton Court Nursing & Residential Home Henlade Taunton Somerset TA3 5LT     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: Gail Richardson     Date: 0 8 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 31 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 31 Information about the care home Name of care home: Address: Ruishton Court Nursing & Residential Home Ruishton Court Nursing & Residential Home Henlade Taunton Somerset TA3 5LT 01823443443 01823443443 ruishtoncourt@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Ruishton Court Ltd care home 33 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Elderly persons of either sex, not less than 60 years, who require general nursing care Up to three persons of either sex, over the age of 50-59 years, who require general nursing care Up to 3 places for personal care Date of last inspection Brief description of the care home Ruishton Court Nursing Home provides general nursing care and personal care for up to 33 older people. The home is on the outskirts of Taunton set in large wellmaintained grounds, which are accessible by wheelchair via a ramp at the front door. The home is formed from a converted hundred-year-old house; accommodation is on three floors with connecting shaft lift. The home has twenty-two rooms used as single occupancy and four double rooms. All rooms have en suite facilities. There are communal dining rooms and two main lounges on the ground floor. There is a Registered Nurse on duty at all times. The current fees scale (correct as of January 2010 ) is from 539.00 pounds to 743.00 pounds and does not include hairdressing, Care Homes for Older People Page 4 of 31 Over 65 33 0 1 5 0 9 2 0 0 9 Brief description of the care home chiropody and newspapers. Care Homes for Older People Page 5 of 31 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: This was an unannounced inspection, which took place over one day (8.5 hours) on the 8th January 2010 by Regulation Inspector Gail Richardson. For the purpose of this inspection the term We will be used when referring to the Care Quality Commission. The last key inspection took place on the 8th January 2008. An Annual Service Review was undertaken on 7th January 2009 and a random inspection took place on the 15th September 2009 following concerns being raised about standards of care at the home. A tour of the home took place and some of the bedrooms and all communal areas were seen. There were 24 people currently residing at the home and one person in hospital. 22 people are receiving nursing care and 2 people are receiving residential care. We spoke to 7 of the people using the service and 9 members of staff, the Registered Care Homes for Older People Page 6 of 31 manager/matron and registered provider, were available throughout the inspection. As part of this inspection we surveyed the opinions of staff members, visiting health professionals and people using the service. Moderate levels of responses were received. Comments received from those surveys and, following discussion with people using the service at inspection, these comments are included in this report. We looked at records relating to care including three care plans, four staff files, finances and health and safety records. The focus of this inspection visit was to inspect relevant key standards under the CSCI Inspecting for Better Lives 2 framework. This focuses on outcomes for service users and measures the quality of the service under four general headings. These are excellent, good, adequate and poor. The following is a summary of the inspection findings and should be read in conjunction with the whole of the report. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: The registered manager is required to ensure that people using the service or their relatives/representatives are recorded as agreeing to the plan of care in place. Care plans need to be further developed to ensure that they include all areas of assessed and changing need to ensure that staff know what care is to be given. The Registered Manager is required to undertake a regular audit of the medication Records to ensure that all records are well maintained and accurate and no gaps are evident. The provision of activities requires further development to promote a more person centered approach and ensure that all people using the service have access to some social and recreational activity on a regular basis. The complaints policy and the whistle blowing procedure were evident but lacked contact details for any external body to contact should a disclosure want to be made. Care Homes for Older People Page 8 of 31 The complaints policy also needs to be updated to include timescales of responses so that anybody wishing to make a complaint will know what response to expect. We are advised that copies stored as records did have the correct contact information. The home must continue its plan of refurbishment to ensure that all bathrooms are of a good standard and have no risk of cross infection. Cleaning solutions around the home must be stored correctly to ensure that there is no risk of accidental ingestion of substances which are hazardous to health. The registered manager must ensure that all recruitment checks are in place prior to the staff member starting work at the home to ensure that there is no risk to people using the service. The registered manager must also ensure that there are consistently sufficient levels of staff on duty to meet the dependancy levels of people using the service. The registered manager is recommended to ensure that 50 of staff have achieved a level 2 National Vocational Qualification in care as recommended by the National Minimum Standards. The Registered Manager is recommended to audit accident records monthly and use the information obtained to promote accident prevention. 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 31 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 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home continues to provide prospective people using the service and relatives with sufficient information in the format of brochures, the Service User Guide and Statement of Purpose for them to make an informed decision about the home. All prospective residents receive a pre admission assessment to ensure the home can meet the assessed needs identified. Staff have collectively, sufficient skills to meet the needs of people admitted to the home. Evidence: The home has produced a Statement of Purpose incorporating the Service User Guide which is made available to prospective people using the service and their representatives. This has recently been updated to contain current detail of the home. Two people using the service confirmed that the home had been chosen by their relatives. We looked at those pre admission assessments. Information had been Care Homes for Older People Page 11 of 31 Evidence: sought on both occasions by the manager, from the previous persons residence to establish that the home could meet their needs prior to admission. We were not able to see copies of the SAP (Single Assessment Process) as these were stored in an alternative file. We were assured by the manager that nobody is admitted to the home without this information having been received. The homes AQAA (Annual Quality Assurance Audit) states that, As much time as possible is spent with people viewing the home to ensure they are comfortable with the surroundings. Full assessments of residents needs are done to ensure these needs can be met. Contracts are issues after one months trial period. The home currently provides end of life care, the deputy manage is undertaking training in this area and the registered manager is confident that the care they provide in this area is of a good standard. The home has a group of relatively new staff employed over the last 6-8 months, staff training is ongoing to ensure that staff both individually and collectively have the skills to deliver the services and care the home offers to provide. One survey told us Gives excellent holistic and practical care,another said I would be happy for a relative to be cared for at Ruishton Court. Contracts were not reviewed at this inspection has they had been seen previously and were seen to contain sufficient information and included the terms of residency. Care Homes for Older People Page 12 of 31 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. Each person using the service has a care plan, most of the assessed areas of need were reflected in this plan of care and the detail recorded ensures that staff can provide for those needs. Further development of the care plan is recommended to ensure all areas of assessed need are care planned. Medication systems were assessed to be mostly good with audits being needed to ensure safe practice. Staff were observed to treat people with dignity and respect at all times and people using the service said that they felt well cared for. Evidence: Each person has a care plan in place to advise staff of the persons needs and preferences. The initial care plan is taken form the pre admission documentation. We were not able to look at an initial care plan as it had been stored when it was updated. We looked at three care plans and found there to be mostly enough detail to ensure that staff were informed of the abilities of people using the service and how their Care Homes for Older People Page 13 of 31 Evidence: independence could be maintained whilst supporting them in other areas of care. The care plans have been updated to include care plans for the night time and some preferences about getting up and returning to bed. However, some areas of care did not have a sufficient plan of care to inform staff and further development must be ongoing to ensure that all areas of assessed need and those areas of changing need are regularly updated and staff informed of the changes. The homes AQAA told us Care plans need a lot of work, from the initial basic care plan to cross referencing of treatment. Some people did not have completed social and recreational care plans. This meant that staff who may be new to the home or agency staff would not know peoples choices and preferences in this area. The care plans contained risk assessments including manual handling and nutritional assessments and evidence of ongoing contact with visiting health professionals. Each area of identified risk had an associated care plan if needed. This means that risks can be managed safely. Daily records were well maintained and seen to be sufficiently detailed. Regular reviews of the care plan were seen to have taken place. There was no evidence of input from relatives or people using the service. The Homes AQAA said All residents have their own care plans, and where possible this is done with input from the resident and or a relative. We met people whos care plans we looked at and found that they would have the capacity to agree and participate in the care planning process. The registered manager is required to ensure that people using the service or their relatives /representatives are recorded as agreeing to the plan of care in place. A recent random inspection had identified that, Some people living at the home were still in bed until almost lunch time. Care plans did not give details of peoples preferred routines and therefore there was no rationale for when people were assisted to get up and dressed. When questioned one member of staff said Its just the routine One person told us that they liked to get up at 9 oclock and they are usually able to do so, unless there are not enough staff to help. At this key inspection we noted in the care plans that some people had included their choices to get up and go back to bed. However, two people were seen to get up at 12:20. Both people were unhappy with this and had wanted to get up earlier but staffing restraints had restricted this. Discussion with people using the service highlighted that this was often the case that peoples preferences could not be met due to staffing issues. People using the service who spoke with us were all complementary about the staff, Care Homes for Older People Page 14 of 31 Evidence: they told us that staff are Kind and loving, Cant do enough for you, Nothing is too much trouble. However several people told us that the home could improve by increasing staffing levels to meet peoples level of dependency. One person has been unable to have a preferred extra bath each week due to staffing constraints and we observed people being in the dining room waiting to be assisted from the dining room to the lounge for periods of time up to one hour. The service is currently undertaking more end of life care. A senior staff member is taking further training in this area. We looked at the care plan for someone receiving this level of care. We found it to be detailed and contained the persons choices of carer with reference to gender. The care plan was detailed in most areas. No social care was identified or recorded. Staff told us the persons preferences but these must be recorded for staff who do not have this level of information. The records were updated at inspection to include end of life choices. There was no input in the care plan by the person or their relatives to ensure that they agreed with the plan of care in place. The medication systems were assessed to be mostly good. Currently no people using the service manager or administer their own medication. The home has moved the treatment room to enable more space and better organisation or stores and equipment. All medications were stored safely and securely with systems in place for ordering and disposal. Qualified staff dispense medication. The Medication Administration Records were seen to have some gaps were there was no record of if the medication had or had not been given. The Registered Manager is required to undertake a regular audit of the medication Records to ensure that all records are well maintained and accurate. Oxygen is in usage and there must be the correct systems in place to ensure that the equipment is maintained correctly. Care Homes for Older People Page 15 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is currently without an activity coordinator and staff do not have the time to undertake activities or do not see this as part of their role. The meals in the home are of a good quality and a wide range of choice is available. Evidence: The home has been without an activity coordinator for one month. A new coordinator has been employed and is about to start work at the home. For the last month no activity provision has been in place, however we have been advised by the registered provider about activities which did tale place over the Christmas period. Discussions with staff showed that staff do not consider activities to be part of their role and the registered manager confirmed that staffing restraints mean that they do not have the time. We observed that for long periods of time people sat in the lounge with no radio, music, TV or magazines / newspapers. In the morning six people sat around the edge of the room and there was no communication. Staff members visited but did not stay or speak with people in the lounge. One staff member asked one service user did she want the TV on, when she said no, nobody else was offered the choice. In the afternoon, eight people sat in the lounge, seven were asleep, Again there was no effort to engage or stimulate the people with any information or music. Care Homes for Older People Page 16 of 31 Evidence: Three people using the service who spoke with us told us that there was little to do. We were told that there is a regular hairdresser and visiting clergy to provide Communion. The provision and recording of activities requires further development to promote a more person centered approach to activity provision. Further staff training is needed to support staff to see their role in engaging and supporting people to be stimulated and active to whatever level is possible. People using the services rooms were decorated in a manner, which reflected their tastes and lifestyles. Evidence was seen in some cases of peoples own furniture and personal items in their bedrooms. This promotes peoples choices and preferences. Specialist equipment was seen in place where there is an assessed need. The home has a lift shaft and ramps into / out of the building to promote movement around the home for those people with a physical disability , one person told us that they go out regularly with family members. The home now has 3 cats and a dog who were seen at the home. Lunch was observed to be a social event with staff sitting in the dining room to support people as needed. Kitchen staff spoken to, had a good understanding of peoples dietary needs. Special diets were available and pureed diets were served separately. Meals were served both in the dining room and in peoples bedrooms if preferred. The dining tables were nicely laid and wine was available. Breakfast is served in peoples rooms with a few people eating in the dining room. Lunch is the main meal of the day with a lighter supper of Soup, sandwiches and suitable alternatives being supplied. The choice was offered for the following day but it was observed that people using the service were able to change their mind if they wanted to. The menu offers a choice and people using the service were complementary and satisfied with the meals provided. People told us that The food is very good, There is always a choice and if you dont like whats on offer they will make you something else. One staff survey told us that the home provides Good food - plenty of choice. Care Homes for Older People Page 17 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff and people using the service are confident that the homes management team would appropriately deal with any complaints or concerns. Training is available to staff to ensure they have the knowledge to prevent people from the risk of abuse. Policies about complaints and Whistle Blowing need to be updated to contain all the correct information. Evidence: People using the service and staff who were asked were comfortable to approach the registered manager or staff with any issues they may have and were confident that any issues would be dealt with appropriately and promptly. The home has a complaints policy which is available within the Statement of Purpose/Service User Guide. There is both a complaints policy and a whistle blowing policy visible in the home. This complaints policy does not contain the timescales which could be expected for a response and does not contain the correct contact details for the Care Quality Commission. We are advised that other copies of the complaints procedure found in the Service User Guide, policies and procedures for the home and staff contracts do include the correct contact details. The copies on display are recommended to be updated to reflect the accurate details needed. The Whistle blowing procedure was evident but also lacked any contact details for any external Care Homes for Older People Page 18 of 31 Evidence: body to contact should a disclose want to be made. This was identified at the previous key inspection. The Registered Provider advised us that the home has received 9 complaints since the last inspection. All complaints have been investigated. The home has access to an advocacy service for people who may require an independent advocate. All people using the service are registered to vote. The home has abuse awareness policies and there is a policy to outline the action to be taken regarding people using the service who may have challenging behavior. Care Homes for Older People Page 19 of 31 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. The home is a large building with some parts of the building suffering from wear and tear that would be typical of a building of similar age and usage. An on going refurbishment program is in place and improvements to areas of the home are evident. Evidence: We looked at most areas of the home and saw a sample of bedrooms, all communal areas , kitchen and laundry. The home is a large Victorian building which has been adapted for purpose whilst maintaining some original features. There is lift and stair access to all three floors with ramped access to outside areas including attractive gardens. Hand rails appear available throughout the home and there is access for wheelchairs to most areas. Specialist equipment is made available where there is an identified and assessed need. Hi Lo beds are available in all rooms seen and pressure relieving equipment and sensor mats were seen to be in use. Peoples bedrooms are personally decorated and well maintained. There is ample communal space available, with a quiet lounge available on the ground floor for visitors to have private space. Where double rooms are used , suitable screening for privacy is provided. Care Homes for Older People Page 20 of 31 Evidence: Toilet and bathing facilities are provided in sufficient numbers and were clean and odour free. One bathroom has been refurbished to a good standard. 2 bathrooms are planned for further refurbishment. The Registered Provider advised that a maintenance plan is in action for further refurbishment of bathing areas. Hand wash, paper towels and foot operated bins are available throughout the home to reduce the risk of cross infection. The general standard of cleanliness was good and no unpleasant odours were evident. One staff survey told us that they felt the home did well by providing a Very clean environment. There is a sluice facility on each floor, cleaning solutions are stored in there and have a lockable facility. It was observed that in two of the sluices the key was left in the lock and the door open and so substances hazardous to health may pose a risk of accidental ingestion. This preactice must be reviewed to remove this risk to people using the service. Care Homes for Older People Page 21 of 31 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing levels at the home appear adequate to meet the assessed needs of people using the service but further staffing increases may improve time available to staff. Staff training is ongoing to ensure that staff have enough information to provide a good standard of care. The recruitment process is not robust and may place people using the service at the risk of harm. Evidence: We spent a full day at the service and observed care being provided throughout the day and spoke with nine members of staff. On duty was the manager, deputy manager and 5 carers. There was also a cook, kitchen assistant and 3 cleaners on duty. There was also contract workers undertaking work in the building. In the afternoon were two qualified nurse and 2 carers on duty . Overnight there is one qualified nurse and 2 care staff. There is always a qualified nurse on shift 24 hours a day. Staff felt there was sufficient qualified staff available. The homes AQAA states that We are considering increasing the amount of carers on duty in the mornings because the dependency levels of our residents are increasing. It is not easy to recruit good carers and I would like to reduce the level of agency use. Numbers of residents continues to fluctuate and we try to keep up with this and their Care Homes for Older People Page 22 of 31 Evidence: dependency levels. As described on Standard 7 and 8, staffing levels are variable and staff are busy with tasks throughout the day. People using the service told us that they received the care they needed but more staff may be beneficial to enable less waiting times. One person told us that if you used the call bell in the night it took a long time for staff to arrive. Very little time is available for staff to spend time talking with people using the service. We looked at staff rotas and it was evident that the two week rota undertaken had a well staffed week and a week were staffing levels were not as many. The weekend following inspection also had lower ammounts of staff available than the following week. We are assured that staffing levels which were seen at inspection to be lower were adjusted and met the required staffing level. The registered manager must ensure that staffing levels meet the dependency of people using the service at all times. Staff surveys told us that they felt there was Good team work, staff pull together, the home provides friendly carers. Our home is very caring. We love to try and make residents lives as happy as possible Staff also told us that the home could do better by More staff more things for the residents to do, so they are not just sitting or sleeping all the time. Staff, we need more so we can spend longer with each person. Im very happy at Ruishton it just the lack of staff which makes me cross. The management of the home have employed a new trainer who is available 15 hours per week. She told us that Moving and handling and Health & Safety are completed yearly with Infection Control and Fire training done six monthly. All other training is offered to all staff members four times yearly these include Safeguarding Vulnerable Adults, Food Hygiene and First Aid. We are awaiting an overview of the staff training to confirm that all staff have received mandatory training. Nine of the twenty six staff employed have completed NVQ 2 in care. This is less than 50 recommended by the National Minimum Standards. The provider confirmed that they are awaiting funding confirmation before proceeding. There have been several new staff start employment at the home. They told us that they felt the induction was appropriate to the role they had undertaken. The induction process lasts two days and includes the Common Induction Standards. Staff receive supervision regularly from the staff trainer and this is then used to develop further training needs. Appraisals are carried out between February and March. Over a year period supervisions are held five times plus 1 appraisal. Care Homes for Older People Page 23 of 31 Evidence: Supervision and appraisals are used to identify issues and further training needs to develop and maintain the standards of care. Four staff files were examined. These staff members had been employed since the previous inspection. The recruitment procedures followed by the home are not robust and may place people using the service at risk of harm. We looked at four staff files for people new to working at the home. We identified that two of those had started work before the Protection of Vulnerable Adults check had been received. One person had a gap in employment history and two people did not have relevant references. Three files seen did not contain a photograph of the staff member. The registered manager must ensure that all recruitment checks are in place prior to the staff member starting work at the home to ensure that people are safe. Care Homes for Older People Page 24 of 31 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 of the service is stable but not all areas of the home are managed safely, this is with particular reference to staff recruitment. The management of people using the service monies in the home is subject to auditing by the home to ensure that monies are handled safely by the home. Records inspected were maintained well and were stored in a confidential manner. Health and safety records are well managed. Evidence: cAll staff and people using the service spoken with at the inspection, were positive regarding the management style of the manager and staff said they felt supported and people using the service felt the manager was accessible. The manager has now completed the Registered Managers Award. Care Homes for Older People Page 25 of 31 Evidence: It is noted that the registered manager has not managed the recruitment of people using the service in a way which would ensure the people using the service are safe and further review of this area of management must be addressed. Quality assurance questionnaires were last sent out in 2009. The manager confirmed that a 45 response had been received. The information has not been collated and an action plan produced. The manager confirmed that any issues raised will have been addressed. People using the service personal finances were held in an appropriate and secure manner. Each person had their own record of transactions, containing and balance and receipts and an individual pocket of money. This was randomly audited and found to be correct. The policies and procedures for the safe storage of records and documents meet the requirements under the Data Protection Act. Policies and procedures available for staff are in the process of being updated to reflect current best practice. Maintenance records were seen to be well organised and managed. We looked at accident records and recommend that these be audited monthly to identify any recurring incidences and trends. This information could be used to promote accident prevention. Care Homes for Older People Page 26 of 31 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 7 15 (1) Care plans must be 30/11/2009 created in consultation with the person living at the home and/or their representative. They should contain up to date information about people needs, wishes and preferred routines. To ensure that people receive care in their preferred manner and to enable any routines in the home to be based around individual needs and choices. 2 19 13(4) The registered provider is required to ensure that bathrooms identified at inspection are repaired to prevent any risk of cross infection. 01/04/2008 Care Homes for Older People Page 27 of 31 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 14 The registered manager 17/02/2010 must ensure that the person using the service or their Representative is consulted about their care plan. This is needed to ensure that the person or their Representative is in agreement with the plan of care. 2 7 15 The registered manager 17/02/2010 must ensure that all areas of identified and changing need are recorded in the care plan and an appropriate plan of care be put in place to meet that need. This is required to ensure that staff are aware of all of each persons care needs. 3 15 16 The provision and recording of activities requires further development to promote a more person centered 17/02/2010 Care Homes for Older People Page 28 of 31 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 approach to activity provision This is needed to ensure that all people using the service have access to social and recreational activity. 4 16 22 The complaints policy does not contain the timescales which could be expected for a response and does not contain the correct contact details for the Care Quality Commission. The policy is required to be updated to reflect the accurate details needed. 5 26 12 The registered manager must ensure that all substances hazardous to health are stored safely and securely. This will reduce the risk of accidental ingestion. 6 27 18 The registered manager must ensure that staffing levels meet the dependency of people using the service at all times. This will enable staff to provide a consistent level of care. 7 30 12 The registered manager must ensure that all staff 17/02/2010 17/02/2010 17/02/2010 17/02/2010 Care Homes for Older People Page 29 of 31 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 have received the appropriate recruitment checks prior to commencing employment at the home. Recruitment checks must be in place before staff commence employment to ensure that people using the service are safe. 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 18 Whistle blowing procedure is recommended to include contact details for any external body to contact should a disclose want to be made. This was identified at the previous key inspection. The registered provider is recommended to ensure that all areas of the home are maintained and refurbished to prove a good standard of environment. The registered manager is recommended to ensure that staff are supported to undertake the National Vocational qualification in care as the home currently has less than 50 recommended by the National Minimum Standards. The registered manager is recommended to audit all accidents and use the information to promote accident prevention. 2 21 3 28 4 38 Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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