Care Home: Ruksar

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What the care home does well People living at the home expressed high levels of satisfaction with the service they receive from staff comments such as the following reflecting this: `Staff are excellent, all is very good in all aspects. I am very happy in all ways. Would like to say a big thank you`. `It is excellent very good` `The home does well everything. I am really happy about my care according to my care plan`. People tell us that staff listen to them and try to provide what they want, this evident in the varied food choices made available that include differing cultural options. Communication with people of differing ethnic backgrounds is enhanced by a number of the diverse staff group being bi-lingual. The staff team also present as knowledgeable and committed to the people living at the home. Medication management was seen to be of a good standard and consequently safe. What has improved since the last inspection? The provider has continued with improvements to the home providing a significant number of large single en suite bedrooms in place of shared rooms as well as replacing a number of windows with doubled glazed units that keep the rooms warmer. The range of meals is under review with the cook now exploring Afro Caribbean meal options. Staff have had involvement with continued training that has maintained the staff team`s knowledge base and skill mix. Examples of training provided over the last year include adult protection and vocational care qualifications. The home now has an appointed activities co-ordinator which will give the organization of activities greater cohesion What the care home could do better: Contact details for the local social services and statutory agencies need to be up to date in the homes complaints and safeguarding procedures, this so people can access these. Overall we saw some improvements are present within documentation but further improvements and attention to detail is still required this including records relating to people`s valuables, the statement of purpose, service users guide and in some cases care plans (the latter as some inconsistencies between what happens and what is written did exist). Recruitment checks for staff need to be consistently more thorough to ensure people coming to work at the home are fully vetted. Some areas relating to the environment need attention this including attention to fire safety issues (as identified by the fire prevention officer); some areas that may compromise infection control; provision of suitable privacy locks for bedrooms; the hot water flow from some hot taps and the variety of the decor of corridors to better identify different areas of the home (to assist people with dementia to orientate themselves). Some people living at the home also felt that more day trips and community involvement would be better as stated ` I would like to see more outings and visits to places` and ` I feel Ruskar nursing home could do with more trips outside.` Key inspection report Care homes for older people Name: Address: Ruksar 26 Park Avenue West Park Wolverhampton West Midlands WV1 4AH     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: Jonathan Potts     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 30 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 30 Information about the care home Name of care home: Address: Ruksar 26 Park Avenue West Park Wolverhampton West Midlands WV1 4AH 01902420605 01902561199 mariamathet@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr Mustak Jalal Name of registered manager (if applicable) Type of registration: Number of places registered: care home 27 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 physical disability Additional conditions: The maximum number of service users who can be accommodated is: 27 The registered person may provide the following category of service only: Care Home with Nursing (Code N); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Physical disability (PD) 27 Date of last inspection Brief description of the care home Ruksar is a care home registered to provide personal and/or nursing care, for up to 27 adults, of all ages, with physical disabilities. Located close to Wolverhampton City Centre the home benefits from easy access to local shops, pubs, parks, and other amenities. The property is a two-storey building with accommodation on both floors comprising Care Homes for Older People Page 4 of 30 Over 65 0 27 0 6 0 2 2 0 0 9 Brief description of the care home bedrooms, communal rooms, bathroom, and toilet facilities. The first floor is accessed via a passenger lift, and there is provision of an access ramp to the front of the home. However, whilst the home enjoys a garden area to the rear there is limited access for wheelchair users. Information of the home and the provision of the service are available in the statement of purpose and a brief brochure. The service user guide is currently unavailable and as such it was not possible to determine the current level of fees for the service. The reader may wish to obtain more up to date information from the care service. Commission for Social Care Inspection reports for this service are available from the provider or can be obtained from www.csci.org.uk Care Homes for Older People Page 5 of 30 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: We did not tell the home we were going to visit , and arrived at Ruskar at 8.40am on the 15th January staying until 3.15pm. We also visited the home on the 21st January arriving at 9.15am and leaving at 3.45pm to conclude our inspection. The visit was carried out by one of inspectors. Before we visited the the home we reviewed all the information we had received about it since our last review of the home, this including information sent to us every year by the homes manager (this in a document called an Annual Quality Assurance Assessment - AQAA). We also reviewed all the other information we have received about the home, this including that from the home (in the form of notifications about such as incidents that they have to legally tell us about) and from other organizations. We also considered the information we gathered through receipt of a number of survey forms, six from people living at the home, three from relatives or representatives and two from health and social care professionals. We spoke to four people who live at the home, two relatives, five staff and the Care Homes for Older People Page 6 of 30 registered provider during our visit. We also looked at care and management records as well as having a look around the building. We also viewed reports from other statutory inspecting bodies. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: Contact details for the local social services and statutory agencies need to be up to date in the homes complaints and safeguarding procedures, this so people can access these. Overall we saw some improvements are present within documentation but further improvements and attention to detail is still required this including records relating to peoples valuables, the statement of purpose, service users guide and in some cases care plans (the latter as some inconsistencies between what happens and what is written did exist). Recruitment checks for staff need to be consistently more thorough to ensure people coming to work at the home are fully vetted. Some areas relating to the environment need attention this including attention to fire safety issues (as identified by the fire prevention officer); some areas that may compromise infection control; provision of suitable privacy locks for bedrooms; the hot water flow from some hot taps and the variety of the decor of corridors to better identify different areas of the home (to assist people with dementia to orientate Care Homes for Older People Page 8 of 30 themselves). Some people living at the home also felt that more day trips and community involvement would be better as stated I would like to see more outings and visits to places and I feel Ruskar nursing home could do with more trips outside. 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 30 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 30 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 sufficient information to allow them to make an informed decision about moving into the home. Robust checks ensure that staff know what peoples needs are before they move in, and can be sure that they are able to meet these. Evidence: We looked at the information available about Ruksar and how this would be provided to people who are looking to move in, or currently live there. We saw the homes Statement of Purpose (a book describing what the service provides and for whom) and saw that this contains details as to the aims of the service and how the staff would intend to meet these. We saw the homes service users guide (a book that tells people how the service works) the second day we visited the home. Between the days of our visits we saw that the information available had been updated to include current phone and contact details for appropriate agencies (such as ourselves). The documents still did not include the homes current fees however (despite these seen to Care Homes for Older People Page 11 of 30 Evidence: be on display in the office). We saw a second copy of the guide was available in an Asian language. Discussion with one of the nurses indicated that it was their intent to make copies of the service user guide available in all the bedrooms to improve access to information. We spoke to the relatives of someone who had recently moved into Ruksar and they told us that the staff had given them sufficient information about the home to allow them to decide. This view reflected what people living at the home told us in our survey forms where 5 out of 6 said that they had sufficient information available to know Ruksar was the right place for them before they moved in. We looked at the home admission procedures and these reflected what staff needed to do to ensure full checks of a persons needs are carried out, this allowing management to decide if they are able to meet their needs. We looked at the assessments staff carried for two people that have moved in recently, and found these to be sufficiently detailed to allow staff to know what they need to do for that person so as to confidently provide for their needs and welfare. The assessments carried out by staff are supported by information/assessments either from social services or health professionals. Most of the people who responded to our surveys (4 out of 6) said that they have received a copy of their terms and conditions with the home. Two said they couldnt remember if they had. When looking at the homes terms and conditions we did however advise staff to ensure that it was clear (if the individual was receiving nursing care) that there was reference to how the fees took account of any free nursing care contributions. The home does not offer an intermediate care service Care Homes for Older People Page 12 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The support and personal care that people receive reflects their choices and preferences, and is provided in a way that respects individuals diversity, privacy and dignity. There are good arrangements in place for the management of peoples medication. Evidence: We looked at a number of care records and saw that these all contained a care plan that was based on the information from assessments that the staff and other professionals had completed. The quality of the plans did however vary, with one of the three we looked at not as thorough as the other two, this explained by a nurse we spoke to as been due to the fact that they had only recently moved in to Ruskar. The nurse told us she was planning to sit down with the individual and their family to discuss the plan. The other two plans we looked at we saw to be far more detailed, building on peoples needs and what their choices and preferences are. We saw that care plans are supported by corresponding risk assessments that highlight ways in which hazards can be minimized. We saw that some of the care plans have been signed by and agreed with individuals. In general the care plans that we saw Care Homes for Older People Page 13 of 30 Evidence: contained sufficient information to allow staff to know what they needed to do to meet a persons needs, and preferences with any gaps explained by the staff we spoke to. We spoke to three people living at the home about their care plans during our visit and they confirmed that what the staff do to support them corresponds with what we saw written in their care plans. The four staff we spoke to also showed a good understanding of what support people needed, this again generally matching what we saw written in care plans. Surveys that we received from people living at the home told us that people received the care and support they needed from staff. (out of 6 returned 4 said this was always the case, 2 usually). Three relatives of people living at the home also told us in surveys that they also thought that care and support was always as expected and agreed. We also received the following comments; I am really happy about my care according to my care plan and (staff) care very well for the residents in the home, We looked at records related to three peoples health care and this showed us that they receive appropriate and regular access to health care professionals such as their G.P., opticians, dentists and chiropody as examples. We also saw that care plans and risk assessments clearly identify where input is required, with any risk identified usually prompting a change to that individuals care. Feedback we received from people living at the home told us that people received the medical care they needed. Comment we received from two health professionals told us that the home is usually good at monitoring health care needs and sought and acted on advice. There was comment that there was occasional concerns regarding the management of diet for diabetics. We spoke to two staff about their knowledge as to how they would respond to changes in a diabetics health and they gave us informed and appropriate responses, this reflecting the training they told us they had received about diabetes management. We did note that one individuals care plan did state that staff should check their blood sugars twice daily, this seen not to be the case when we discussed with a nurse and asked to look at records of the same. Whilst the nurse gave a good verbal explanation as to why the staff did not carry out these checks at that the stated frequency it is important that information in the plan is accurate and where there are changes these reflect the appropriate doctors directives. We also saw that the staff weigh people living at the home on a regular basis so as to ensure people are not losing or gaining excessive weight, but we noted that whilst the home has, and in cases uses a body mass indicator tool for some people, this is not consistently applied for all. We saw that the home has a robust medication policy in place. We looked at the Care Homes for Older People Page 14 of 30 Evidence: medication records for three people living at the home, medication storage and generic medication records. We judged that the home has good arrangements in place to ensure the safe management of medication. We did suggest to the nurse in charge that an external audit of medication arrangements by the homes contracted or Primary Care Trust pharmacist would be useful for the homes own audit purposes. We saw through observation during our visits that the staff work hard to promote peoples dignity, with observation of practice (such as when transferring a person on a hoist) showed staff talking to people when caring for them, telling them what was happening and taking time to listen to what the person was saying to them. Care plans make reference to communication and language. This is supported by a diverse staff group that can communicate in a number of languages. We saw that staff knocked bedroom doors before entering peoples rooms. Discussion with some of the staff showed us that they are aware of the need to promote peoples dignity and spoke to us of observing such as individuals preferences as to the gender of their carer and how important it was to ensure personal care was given in private. Care Homes for Older People Page 15 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is access to activities that reflects the individual preferences and needs of people living at the home, but development of more community activity would improve peoples satisfaction. Meal provision caters for the cultural and dietary needs of people, with sensitive and appropriate support available to encourage people to have a good diet. Evidence: People living at the home and those representing them have told us that the support they receive from staff is centered around their personal choices, expectations, and cultural diversity. A key issue we saw is that bi lingual staff are able to converse with Asian elders in their first language. We saw, with one exception, plans highlighted what people wanted and discussion with those people, whose plans we looked at confirmed that this was generally what the staff provided, this includes access to opportunities for observance of their chosen religion. The homes guide to the services that are offered tells people about the range of activities the staff aim to provide - monthly birthday parties, musical events, games, outdoor activities, trips and tours, books, arts and crafts programme. People told us Care Homes for Older People Page 16 of 30 Evidence: that they are always or usually happy with the stimulation they receive although some have told us that they would like more trips out, this summarized by the following comments: I feel Ruskar nursing home could do with more trips outside, also more trips outside by coaches to see sites and I would like to see more outings and visits to places. However they always try their best. The previous manager of the home did tell us that stimulation was an area that the home was looking to review, and this commitment has been shown through the allocation of an activities co-ordinator role to a specific member of staff, with plans to provide this individual with training to assist them with their duties. We spoke to this member of staff who shared their ideas for how them are looking to develop stimulation for individuals, this including community outings that capitalize on the homes position opposite West Park, which is the venue for numerous city events. We looked at records that confirmed people have access to frequent and appropriate simulation and activity that reflects their choices. We heard from friends and family that they are able to visit at suitable times and arrangements to support this by the home are very satisfactory. This reflects the visitors policy that we saw. We have been told that relatives are kept up to date on any developments by the staff. People are able to access their bedrooms to have privacy with visitors, or there are other available spaces within the home where privacy is available. We saw that there are a varied selection of meal choices available that include English and Asian cuisine. This meets peoples preferences. People are encouraged to make use of the homes dining area but have the choice of eating elsewhere if they so choose, this where they wish and also at the time they wish. We saw that thought is given to ensure diets reflect needs and choice, with the home providing meals that use halal meat, and including gluten free foods. At the time we visited the home we saw that the cook was exploring Afro-Caribbean dishes reflecting the choices of an individual who had recently moved in. We observed that staff assist people with feeding where needed, with soft diets presented so that separate tastes are preserved. The assistance we saw staff offering people at meal times was patient, discreet and encouraging. In discussion with the cook they showed an enthusiasm in regard to offering people varied choices, and is keen to enhance their training and knowledge. We saw that the homes menus are available with pictorial support. We did suggest the use of photos of the meals prepared by the cook as opposed to pictures taken from magazines as these would better reflect the meals available at the home. Care Homes for Older People Page 17 of 30 Evidence: Care Homes for Older People Page 18 of 30 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 home feel able to complain, and are confident that the staff will resolve any concerns they may have. Staff have a good awareness of how to protect people living at the home although some areas of record keeping could be better. Evidence: The homes guide contained details of the complaints procedure. This states that there is a 28 day response time to any complaints raised. Out contact details within this document are however out of date with reference to an unavailable phone number. Another complaints procedure on display in the home carried different contact details for us, which are also incorrect. We saw that the home has recorded complaints they receive and the response made to resolve the issues raised. People told us that they are aware of the homes complaints procedure and people living at the home said they are able to speak to some one informally if they have any concerns. With little exception people living at the home said that staff listened to them and where possible puts things right. The home has a clear and detailed procedure that tells staff what action they need to take if there are concerns about abuse of, or the safety of people living at the home. This procedure carried out of date contact numbers for the local social services and CQC. We spoke to some of the staff as to their awareness of safeguarding procedures and found that they are knowledgeable as to their responsibilities, although had some difficulties when asked about relevant contact numbers in the homes records. We Care Homes for Older People Page 19 of 30 Evidence: asked about the homes policy on deprivations of liberty safeguards and the senior nurse on duty at the time knew what actions they should take. We have been told that the home is planning to train staff so that they have a better awareness of the mental capacity act for their practice. We saw that the home has acceptable policy and procedure in place to safeguard peoples finances and valuables, this very clear as to what staff should record. The records of all peoples monies in safekeeping are kept in one bound book. We advised the nurse that separate records should be kept for each individual so as to allow confidentiality should there be a request to access records. We looked at some of the inventories of property people living at the home have brought in with them and some of these needed update (one with the last entry as 2006 and another carrying no record of jewelery we saw someone wearing). Records of peoples monies in safekeeping we saw are generally well recorded but we saw odd occasions where there was only one signature to verify a transaction. When we sampled the balances against the records we did find that these balanced, and there are receipts available. Care Homes for Older People Page 20 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The physical design of the and layout of the home offers people that live there a comfortable environment that is generally safe. Privacy has been enhanced through increased single room accommodation. Attention to some areas would further enhance privacy, safety and prevention of infection. Evidence: Ruskar is a traditional property that is well positioned in that it is sited near to Wolverhampton City centre and West Park. Access to the home is facilitated by ramped access to the front door. We saw that the provider has carried out works to convert many of the bedrooms to single with an en suite facility this providing better facilities and more access to privacy for occupants. We saw a number of bedrooms and saw that a number of these are personalized to reflect the occupants wishes. The home has ample communal space available, and we saw that the windows in the house are low enough to allow people to see out of them whilst sat down, or in a wheelchair. We also saw that many of the windows in the house have been replaced with UPVC double glazed units, these affording more comfort. The home we saw has various adaptations that are in keeping with the needs of the people living there, this including a shaft lift, adapted bathrooms, hoists and handrails. Care Homes for Older People Page 21 of 30 Evidence: We saw the homes repairs book and this showed that there was a clear record of minor works and completion of these. We also looked at the records for the servicing of equipment within the home and this was made available, verifying the former was safe to use. The only exception was the gas safety check on the dryer, the nurse on duty seen to arrange this with the contractor in our presence on one of the days we visited. We did see that there are some issues that would benefit from attention as follows: There was a gap in one fire door (due to removal of a lock) and it was unclear as to whether the locks on the one emergency exit were altered in accordance with the expectations of the fire prevention officer following their last inspection in April 2009. Many of the bedrooms are fitted with mortice locks meaning that if locked from the inside staff would not have access in an emergency. This would prevent people holding keys to their rooms if they so wished due to safety considerations. Locks should be fitted that met the expectations of the fire service, meaning that they can be locked but access is available if needed. We noted that there are issues with the flow of hot water from taps in some rooms, with the water cutting out at the point it became warm. Some of the decor in the corridors could be improved as some of the corridors are long and quite bland, this noted to be an issue for one person who when first moving in had some difficult recognizing where they were. Orientation could be helped with differing decor and items that helped with orientation. This could be pictures, photos on bedroom doors or differing colours for different corridors. We saw that overall the home was clean and fresh. This was confirmed by people who responded to our surveys. We did note that the presence of a chip on the 1st floor bath, a cracked tile in the room this is in and surface damage (scratching) to the downstairs sluice would not help with infection control. We also noted some bedding was stored on the floor in a storage cupboard (this possibly due to limited space) despite the staff trying to minimize this through use of containers. We saw that the home does have suitable infection control procedures in place and there are regular audits carried out. Education is promoted through notices publicizing hand wash techniques, with this supported by provision of liquid hand wash, paper towels and in the foyer an antibacterial hand gel dispenser for visitors. Care Homes for Older People Page 22 of 30 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. People living at the home are supported by staff that are trained, skilled and available in sufficient numbers to meet their needs. There is scope to improve the homes recruitment practices. Evidence: We looked at the homes duty rota and saw that the staffing levels shown on this are consistent with those we saw at the home at the time of our visits. People living at the home told us that the care they receive is in accordance with their expectations this indicating there are sufficient staff available. We saw that staffing levels are consistent with the information we saw in the homes statement of purpose (guide to the home). We received positive comments from people we spoke to through surveys from those living at the home and their relatives: Ruskar is a caring home and no matter what time of the day I visit my dad is always clean shaven and in clean clothes. I am more than happy with the care they give him. Care very well for the residents in the home. The home does well everything. I am really happy about my care according to my care plan. Care Homes for Older People Page 23 of 30 Evidence: Staff are excellent, all is very good in all aspects. I am very happy in all ways. Staff get on well with me One of the strengths of the service is the diversity of the staff team which reflects the cultural make up of the people living at the home. The skill mix and make up of the staff team are appropriate and sufficient to allow the service to met the needs and choices of people living at the home. We spoke with senior staff and looked at the homes training plan and sampled certificates in staff files. The majority of staff now hold a vocational qualification in care at either levels 2 or 3, this reflecting the positive and knowledgeable response we received from staff in discussion with them. Whilst there are some areas where training needs update the nursing staff we spoke to showed an awareness of where updates are needed. Staff we spoke to confirmed that they are well supported by training provision. We saw that the home has a robust staff induction that prepares new staff for the work that they do, and the support that they need. We looked at records for three staff (including one nurse), these readily available when requested. We saw that one applicants records did not contain their full working history and whilst we saw two references in place we could not ascertain if one was from the their last employer. The second staff file we looked at showed that there was only one reference in place. Based on the dates of when this person started at the home they commenced their induction prior to receipt of an enhanced disclosure and we saw no evidence that there had been a check on the barring list through the ISA (independent safeguarding authority). We were told by nurses that she did not commence working with people living at the home independently until receipt of their enhanced disclosure and was only involved in the induction which meant she was under full supervision. We would have expected to have seen a risk assessment in place to show how the home was taking steps to protect people living at the home from staff who had not been fully vetted. The records for the last person employed at the home we saw are complete, this including an enhanced disclosure. We saw that the provider checks the pin numbers for nursing staff with the Nursing and Midwifery Council. We saw from records that staff have regular supervision and when we spoke to individual staff they confirmed this. We saw some recording of staff meetings but found that the quality of these records in some cases could be better, although more recent records showed improvement. Care Homes for Older People Page 24 of 30 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. There are areas that require improvement to build on positive outcomes experienced by people living at the home, this to ensure that vulnerable adults are safeguarded and protected from harm. Evidence: We saw the that the homes certificate of registration was on clear display and verified that this was up to date and reflected the needs of those people living at the home, and the Statement of Purpose. We did see that the bed capacity of the home has decreased, this due to improvements, with conversion of shared rooms to single en suites meaning that the home can now only accommodate 22 as opposed to the 27 it is registered for at present. The registered manager for the home had filled the post since 2007. Due to the fact that we had not met with her at the last key inspection of the home, we returned to Ruskar on a second day, this to coincide with when the manager was on duty. We found that the manager had resigned at this point. The registered provider did tell us Care Homes for Older People Page 25 of 30 Evidence: that a new manager was due to commence at the home (now known to have taken up their position at the time this report was written). We saw evidence to show that the new acting manager is experienced and has appropriate qualifications, and the provider has undertaken thorough recruitment checks. The provider told us that an application for the acting managers registration will be submitted to us as soon as possible. The provider was honest with us as to the current financial climate impacting on the home, but despite this has shown commitment to the service through improving the facilities available over the past twelve months through the conversion of bedrooms and the replacement of some windows. We also saw that he is available at the home on a regular basis so as to support the business. There have been some difficulties over the past 12 months with a health and safety executive inspection leading to the issuing of an improvement notice (this relating to the the assessment of slings for use with person lifting hoists). We saw that the provider had responded to this and addressed shortfalls promptly. A recent Environmental health food safety inspection also resulted in the home awarded a two star rating with a number of areas needing improvement. The cook showed us that the home is working toward addressing these so as comply with food safety legislation. We saw that the home has systems in place to encourage consultation with people that use the service and that records, documents and certificates are available, including health and safety checks, accident records and risk assessments. There is scope to improve records in some areas as previous mentioned earlier within this report. Of importance is the fact that the home needs to develop its audit systems to the point where it can identify issues, and improve the home without the intervention of regulatory agencies. Such an approach may have allowed the home to achieve a better rating from environmental services, ourselves and avoid the possibility of improvement notices. Care Homes for Older People Page 26 of 30 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 27 of 30 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 18 13 The homes complaints and safeguarding procedures should contain up to date contact information for the local social services and any other appropriate agencies. 30/04/2010 This is so people can contact appropriate agencies without delay should there be a need. 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 1 The statement of purpose or/and the service users guide should carry the homes range of fees so that people moving into the home have ready access to this information. The registered provider should ensure that terms and conditions for those people recieving free nursing care carry reference to this in the breakdown of fees. Peoples care plans should be updated with the individual 2 2 3 7 Care Homes for Older People Page 28 of 30 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 concerned as soon as possible after they move into the home, this to ensure that they are agreed and content is sufficiently detailed to reflect all their support needs. All care plans should also accurately reflect the exact support that staff offer to people living at the home, this to be maintained through regular updates that reflect all/any changes. 4 8 The home should use a body mass indicator tool universally, this as an indicator of peoples general health, and as to whether any weight loss or gain is of cause for concern. Inventories of peoples property should be accurate and updated on an ongoing basis. Individual records should be maintained in respect of any monies the home may safe keep on behalf of people living at the home. Consideration should be given to decorating corridors so that they assist with peoples orientation around the home. The home should clarify with the fire prevention officer that the steps taken following their last inspection are satisfactory. Suitable privacy locks should be fitted to bedroom doors that do not compromise peoples safety. Appropriate action should be taken to ensure that there is a ready supply of hot water (up to 44 degrees) to all rooms in the home. Attention should be paid to minor environmental issues that may compromise control of infection. To ensure that the home has a record of staffs full working history, obtains two references prior to their employment and documents the steps taken to ensure people at the home are safe if employed prior to an enhanced disclosure is received (this in the form of a risk assessment). 5 6 18 18 7 8 19 19 9 10 24 25 11 12 26 29 Care Homes for Older People Page 29 of 30 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. 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. 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