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Care Home: Rutland Manor Nursing Home

  • 12-14 Rutland Road Ellesmere Park Eccles M30 9FA
  • Tel: 01617071218
  • Fax: 01617878127
  • Planned feature Advertise here!

Rutland Manor Nursing Home is located in a residential area of Ellesmere Park, Eccles. The home provides nursing and personal care for up to 30 older people. Accommodation is provided on three floors and there is a passenger lift to each floor. There are two lounge areas, which are suitable for wheelchair users. Both these rooms have wide screen televisions. The home is set within its own grounds with a designated parking area. The motorway network is accessible to the home and provides ease of access for friends and relatives. Fees for the home are between GBP 382 and GBP 488 per week. There are additional costs for hairdressing, newspapers and toiletries.

  • Latitude: 53.49100112915
    Longitude: -2.3389999866486
  • Manager: Manager Post Vacant
  • Price p/w: ~
  • UK
  • Total Capacity: 30
  • Type: Care home with nursing
  • Provider: Rutland Care Home Ltd
  • Ownership: Private
  • Care Home ID: 13475
Residents Needs:
Old age, not falling within any other category, Physical disability

Latest Inspection

This is the latest available inspection report for this service, carried out on 26th April 2010. CQC found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

For extracts, read the latest CQC inspection for Rutland Manor Nursing Home.

What the care home does well The home provides a homely, clean, pleasant and comfortable environment for people to live in. People who could express a view spoke favourably about the environment and some people said they liked their bedrooms and felt the standard of cleanliness in the home was generally good. The atmosphere in the home during the visit was relaxed, friendly and welcoming. One staff member said, "The size of this home ensures we are able to know each service user well, we are like a close knit family." The staff know the needs of the people living at Rutland Manor well. The home has flexible visiting arrangements and visitors stated they were always encouraged to visit and it did not matter whether it was day or night. People spoken to were generally pleased with the care provided. One person said they received the care and support they needed and had found the support they received from the staff good. "The staff are always kind and helpful but I know they are busy."People had their health care needs monitored and received support from professionals as needed. Six of the care staff at the home have successfully completed a National Vocational Qualification (NVQ) in health and or social care and seven staff are working towards this. During the visit three people said the food was good, one person said, "They do make proper meals here, it is always tasty." People who were asked about complaints said they always knew who to speak to if they had any concerns and they were aware of how to do this. Staff and two people who lived at the home said they found the new manager "To be getting things done and he was very approachable." What has improved since the last inspection? Since the last inspection staff have improved the new care plans by using a more person centered approach and have introduced life history sheets to each person`s care file. The care plans need to be more detailed to show the person`s likes and preferred way of receiving care. Improvements have been made to the recording of a person`s skin condition on a body mapping tool and to the monthly reviews of the care plans. A key worker system has been introduced so the staff know which people they have lead responsibilty for in relation to record keeping. There have been some improvements to the training provided for staff, this needs to continue so all staff have recieved mandatory training and other training relevant to their role. There have been improvements made to all the policies and procedures made available to staff. There have been some improvements made to the environment however this programme needs to continue. What the care home could do better: The improvements made to the systems in place for the management of medication noted at the last inspection do not appear to have been maintained. The manager need to make sure that a robust system is in place to keep track of medicines and this is followed. Shortfalls in the receipt, administration, ordering and stroage of medicnes may lead to people not recieving their medicines safely or as prescribed. There was a shortfall in some completed risk assessments, for example oral care, manual handling and continence for some people. The manager needs to monitor and review the deployment of staff in the home to fully meet the needs of the people living at the home. The way people are supported at mealtimes and the way meals are served could be improved. One person said, "It was hit and miss if the meals were hot, but the staff are busy." The manager needs to provide some more social and recreational activities to satisfy people`s recreational, social interests and needs. The auditing of care practices and records needs to be established and developed to make sure they meet the required standard. Key inspection report Care homes for older people Name: Address: Rutland Manor Nursing Home 12-14 Rutland Road Ellesmere Park Eccles M30 9FA     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: Elizabeth Holt     Date: 2 6 0 4 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Rutland Manor Nursing Home 12-14 Rutland Road Ellesmere Park Eccles M30 9FA 01617071218 01617878127 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Rutland Care Home Ltd Name of registered manager (if applicable) Manager Post Vacant Type of registration: Number of places registered: care home 30 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The registered person may provide the following category of service only: Care home with nursing (N) To service users of either gender. Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) 30 Physical disability (PD) 4 The maximum number of service users who can be accommodated is 30. Date of last inspection Brief description of the care home Rutland Manor Nursing Home is located in a residential area of Ellesmere Park, Eccles. The home provides nursing and personal care for up to 30 older people. Accommodation is provided on three floors and there is a passenger lift to each floor. There are two lounge areas, which are suitable for wheelchair users. Both these rooms have wide screen televisions. The home is set within its own grounds with a designated Care Homes for Older People Page 4 of 30 Over 65 30 0 0 4 Brief description of the care home parking area. The motorway network is accessible to the home and provides ease of access for friends and relatives. Fees for the home are between GBP 382 and GBP 488 per week. There are additional costs for hairdressing, newspapers and toiletries. 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: This key unannounced inspection included a site visit. The manager and the staff did not know the visit was going to take place. All key inspection standards were assessed at the site visit and information was taken from various sources which included observing care practices, talking with people who live at the home, visitors and members of the staff team. We sent the manager a form called an Annual Quality Assurance Assessment (AQAA) before the site visit to tell us what they did well, how they had improved within the past 12 months and their plans to develop. We considered the responses and information the manager provided and have at times referred to this in the report. Before the site visit people living at the home and staff were sent surveys asking them to comment on the service. No surveys were returned from people living at the home and four were returned from staff members. Information from these surveys has been Care Homes for Older People Page 6 of 30 used in the report. We also gathered information from the homes reporting procedures which are called notifications and information we may have received from other people such as the general public and professional visitors. A partial tour of the building was conducted and a sample of care and staff records was looked at, including employment and training records, peoples care plans and staff duty rotas. Since the last inspection there have been changes in the management arrangements for the home. We had been told there was a new manager in post and he planned to submit his application to be the Registered Manager. No complaints had been made directly to the home or the Commission since the last visit. We have been informed of two investigations which have been looked at independently under the Local Authoritys safeguarding procedures. Recommendations for good practice came out of both these referrals which the manager has stated have been acted upon. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? Since the last inspection staff have improved the new care plans by using a more person centered approach and have introduced life history sheets to each persons care file. The care plans need to be more detailed to show the persons likes and preferred way of receiving care. Improvements have been made to the recording of a persons skin condition on a body mapping tool and to the monthly reviews of the care plans. A key worker system has been introduced so the staff know which people they have lead responsibilty for in relation to record keeping. There have been some improvements to the training provided for staff, this needs to continue so all staff have recieved mandatory training and other training relevant to their role. There have been improvements made to all the policies and procedures made available to staff. Care Homes for Older People Page 8 of 30 There have been some improvements made to the environment however this programme needs to continue. What they could do better: 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 are given information about the service and have their needs assessed so they know that the home can meet their needs. Evidence: Information about the home was available in the reception area and information was given to prospective people before they moved in to Rutland Manor. One person stated they had received a booklet about the home and found this useful. We looked at pre admission assessments for three people which contained appropriate information. The deputy manager who is a registered Nurse had carried out the assessments and the manager stated he would be involved in this process too. The information provided showed the basic information based upon the persons needs. Copies of care managers assessment and any information from other professionals was available so the home could make sure they can meet peoples care needs. The information gathered was used to start to write the persons care plan. Records Care Homes for Older People Page 11 of 30 Evidence: showed that prospective people had been spoken to about their needs and their preferences for care support. The home does not provide intermediate care. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The systems and practices in place for monitoring and recording the health care needs of people who live at Rutland Manor are not consistent which means their care needs may not be fully met. Evidence: During this visit we looked at the care plans for three people and the person to whom the care plan belonged was spoken to where possible. A requirement made at the last inspection for care plans to clearly record any changes in a persons skin condition or bruising on a body mapping tool had been addressed. The manager explained that care plans were being re written into a new more person centered format which encouraged the staff to include more detail. The new care plans looked at included information about a persons activities of daily living, a range of associated risks and care plans which gave staff instructions on how to meet each persons needs in the way the individual liked. Although improvements were seen, there were some shortfalls in the care plans looked at. Examples included, for a person who had recently moved into Rutland Manor, there was no moving and Care Homes for Older People Page 13 of 30 Evidence: handling assessment completed. Staff spoken to could explain the support this person needed to safely transfer from bed to chair. For others the personal preferences or wishes of an individual were lacking and some of the information lacked detail. For one person the changes in their health care needs in terms of updating the care plan were lacking. For another person there was a care plan in relation to their PEG site however no detail about the management of their medication and the PEG and the care plan had not been updated to reflect how the site should be managed as it had become red and moist. There was no evidence to show the care plans are audited to show these accurately reflect the needs of the people accommodated. Shortfalls in updating the care plans to show these reflect the changing health care needs of individuals may lead to peoples needs not being met in full. Care plans included a professional visits record which showed advice was sought from other professionals. A sample of risk assessments looked at showed these had been updated and were in place in relation to nutrition, falls, pressure sore prevention, bed rails and mobility. For two people there was no oral hygiene or continence assessments where the assessment showed they needed support in these areas. A recommendation was made at the last visit for all risk assessments and care plans to be reviewed and monitored to make sure information is current and staff are updated in relation to the level of support needed. A system was in place for all care plans to be reviewed monthly and staff were updating these. It was clear the staff had worked at improving the care plans and there were some examples of good practice in the new care plans, it was clear the records still required more detailed information and staff need further development to fill these in well. People spoken to during the visit were generally happy about the way their care needs were met. During the visit we looked at how medicines were managed. The administration of medicines was observed. The morning medicines were not finished until 11.45, we were told this was in part due to the particular demands on this morning. The Registered Nurse stated she did normally finish these at 10.15. Staff need to remain mindful of the timing of when medicines are given out to ensure this is in line with Care Homes for Older People Page 14 of 30 Evidence: their prescribed times and they receive these in line with the guidance for the particular medication. A recommendation was made at the last inspection for staff to make sure the system in place to keep track of medicines is followed. There were some shortfalls in the record keeping for medication in relation to the receipt, administration and safekeeping. Not all medication could be properly tracked and accounted for. For one person on antibiotics, two more than prescribed had been removed from the packet, for another person on a liquid medicine there were still 50mls left and this could not be clearly accounted for. The improvements made at the previous inspection do not all appear to have been maintained. Regular auditing and checks of the medication must be made to ensure the medicines are given safely, as prescribed. For one person, the medication administration charts showed a tablet was signed as not given and the tablet was not in the blister pack, the following day the tablet was signed as given but the tablet was still in the blister pack. Tablets had to be borrowed from one person because the staff had not managed to get their medication on time. The manager stated he was dealing with this as a separate incident with the individual staff members. Improvements were needed to the management of creams for people. One person had creams in their bedroom which were not labeled for them and for another person the number of doses of cream applied were not in line with the signatures on the medication administration chart. We talked about the need to introduce a body mapping chart to hold with the MAR chart to show specifically the amount, frequency and type of cream to be applied. Improvements should be made to the record keeping for people who need their drinks thickening so there is an accurate record of the fluids given. For one person the thickener is prescribed as 2 scoops for every 200mls. This information was not included in the persons care plan where staff could access this and the care staff stated they were the ones who did thicken this persons drinks. A recommendation was made at the last inspection for staff to respond to people in a timely manner so their needs can be met and their dignity respected. There were times during this visit that people could not have their needs met in a timely manner due to the demands on the staff to attend to other people. People spoken to did feel the staff respected them as individuals. One person said, They are good staff here they always let me have a lie in when I fancy one. It was clear the staff knew the people living at the home very well and two visitors spoken to said the staff were always kind and friendly and took time to get to know them. One staff member stated,The size of this home ensures we are able to know Care Homes for Older People Page 15 of 30 Evidence: service users very well, we are like a close knit family. Care Homes for Older People Page 16 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. Some opportunities for people to take part in activities remain in place and people were provided with food which they enjoyed. Their social lives would be enhanced by providing more activities. Evidence: An activities organiser is employed at the home for two half days per week, however we were told if the activities person was not on duty the planned activities would not be carried out. We discussed with the manager they should not be displaying a programme of daily activities if they were aware they would not be carried out. Staff, visitors and from observations made during this visit showed there was a lack of activities. On the day of this visit two televisions were on in the lounge area and although there were a number of people present in the lounge only one person confirmed they were watching it. Staff should ask people in case they would prefer times during the day without the televisions on. Other people slept in their chairs for lengthy periods of time and no activities were observed to be carried out. The manager agreed that providing appropriate social activities was something the service needed to improve upon. He explained that he hoped the activities person would enroll on a National Vocational Qualification (NVQ) training course in activities to help them further develop this area. Care Homes for Older People Page 17 of 30 Evidence: The home has an open visiting policy and the staff and visitors confirmed this was the practice. People said they could meet with their visitors in private if they wished. Since the last inspection there were some improvements seen in the recording of activities carried out in the persons care plan and life history sheets had been introduced. As raised at previous inspections some people remained in their bedrooms for the day, it was difficult to establish how much time staff spent with these people. For one person the care worker had left the persons lunch in front of them and then left the room, this person was unable to eat their lunch from the position they were in and staff had to be called to position them appropriately. The issue of staff having sufficient time to carry out tasks in an unhurried way was discussed with the manager and the number and deployment of staff on duty to meet the needs of the people living at the home must be reviewed.(See Staffing section). The main meal of the day looked appetising and people who expressed a view said they enjoyed the meals provided. Since the last inspection the manager stated he had created a dining room in the small lounge, we were told people were still reluctant to eat their meals although staff stated they did try to encourage people. The menu was displayed on a chalk board upon entering the lounge. Two people we spoke to were not aware of what was for lunch although one person said, Oh I get what I am given. Staff said they did remind people what was on the menu and a list showing people had a choice of meal was available. During the course of the visit we saw times when people living at the home and staff communicated well with each other, which showed that healthy relationships had been made. At other times staff were observed to be too busy to have the chance to chat to people and people were left for lengthy periods of time with no one to talk to. People may feel isolated if they are left without conversation or any meaningful interactions. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People felt able to raise concerns and these would be listened to. Policies and procedures are in place to protect people from harm. Evidence: A complaints procedure is available in the Statement of Purpose and one is on display in the home. Two people spoken to said they knew who to speak to if they had any concerns and they felt confident the manager would sort out issues for them. We were told people receive a copy of the complaints procedure in the information they are given when they move into the home. A complaints record was available and the manager had a positive attitude towards complaints seeing them as a way to improve the service. There have been no complaints made directly to the service since the last inspection. Two staff were clear about the procedure to follow in the event of an allegation of abuse and stated they had been encouraged to read information about this at the home. One recently employed staff member had not yet received safeguarding awareness training. When asked about the process to make a safeguarding referral, they were unclear of the process to follow in the event of an allegation of abuse being made. Two safeguarding referrals have been investigated under the Local Authoritys safeguarding procedures, one as a result of action taken by the staff at the home. Due Care Homes for Older People Page 19 of 30 Evidence: to the time lapse for the referral, this highlighted the need for further staff training in the process. The other investigation highlighted shortfalls in the home not checking appropriately the medication a person was discharged from hospital with against their medication adminstration record (MAR). The manager confirmed that procedures had been put in place to carry out another pre admission assessment prior to a person being discharged back to the home from hospital and to check documentation particularly in relation to medication. We were told the training plan includes safeguarding adult awareness training. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People would continue to benefit from the planned redecoration and refurbishment programme to provide a comfortable, homely environment to meet their needs more fully. Evidence: A partial tour of the home was carried out which showed some improvements to make the environment more homely. The home was generally clean and comfortable for the people living there. The manager recognises some of the issues in relation to improving the environment and included them in the self assessment, for example he has plans to improve the garden and patio area to make it more pleasant and to provide more furniture. A number of bedrooms were seen and although personalised with photographs and pictures, these would benefit from the continued programme of redecoration and refurbishment. The carpet on the first floor landing has a large stain where the colour has faded away, this takes away from a homely look and curtains in some bedrooms were not appropriately hung. As raised at the last inspection we discussed the need for plans to be made for a sluicing disinfector, the current practice remains where the staff rinse the commode buckets in the upstairs sluice room. This has the potential to put people at risk of cross infection and serious consideration should be given to an appropriate disinfector. Two visitors to the home stated they felt the home was kept clean and tidy and both Care Homes for Older People Page 21 of 30 Evidence: said there were hardly ever any unpleasant smells. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Rutland Manor receive care and support from staff who have access to training but fluctuating staffing levels may affect the ability of the staff to meet peoples care needs in full. Evidence: On the day of this visit there were 19 people accommodated. There was 1 Registered nurse and 3 carers on duty, the manager had planned to go on escort duty, a care worker accompanied the person to hospital instead. We were told and the duty rota confirmed that one person had phoned in sick at short notice and the manager had been unable to replace this person at short notice. During this visit we observed there were periods of time when peoples needs could not be attended to because there were not sufficient staff to attend to their needs. Staff and visitors spoken to during this visit felt the home was sometimes short of staff. One relative said their wifes finger nails were often unclean. From observation of two people these were seen to be unclean. The manager advised us this would be addressed as a matter of urgency. Two visitors spoken to said they had seen people having to wait for assistance because staff were too busy to attend to them straight away. Surveys were returned from four staff members. In response to the question, What could the home do Care Homes for Older People Page 23 of 30 Evidence: better? One person wrote, More staff so staff are not under pressure and so staff can spend quality time with residents. Three people responded in the survey saying there are Usually enough staff to meet the individual needs of people who use the service and one person said sometimes. Staff were heard saying to people, In a minute when they asked for attention. As raised at the last two inspections, the staffing levels and depolyment of staff must be monitored and reviewed to make sure sufficient staff are on duty to meet the neeeds of the people living at the home. We saw a sample of staff files. These included copies of application forms and two written references. We saw that Criminal Records Bureau (CRB) checks had beeen carried out for new staff. We saw that staff files contained photocopied documents, for example, passports, utility bills and training certificates. We saw these documents had not been signed and dated to show the originals have been seen. A recommendation was made that copies of original documents given as proof of identity be signed and dated to show that the originals have been seen. We saw the manager had started to develop a training schedule and some staff said the training had become better. The manager stated he had a commitment to staff training and plans to develop their individual training needs. One staff member stated, I feel we are developing better as a team and communication between us is better. Staff spoken to said they did receive formal supervision and the manager had a system in place to record this. Six of the staff hold a National Vocational Qualification in Care or Health and Social care and seven staff were in the process of studying for NVQ level 2. We saw some copies of induction records for exisiting staff. The manager stated he planned to introduce Skills for care induction which would be more thorough. 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. Further work is needed to ensure systems are in place to monitor care practices and record keeping to identify areas for development and improvement and to safeguard the interests and well being of people living at Rutland Manor. Evidence: Further changes since the last inspection in the person appointed to take over the day to day running of the home have been made. At the time of this visit the new manager had been in post since November 2009. He has plans to submit his application to be registered with the Commission. Since he has been in post he stated he has revised the policies and procedures, reviewed and updated the care plans, planned for staff training and made some improvements to the environment. He told us he has a number of years as a manager in a care setting. Staff said the new manager was supportive and one person said, I think he will bring the home the leadership and stability it needs. Another staff member replied in the survey, We have a new manager who is doing a good job, trying to make us aware of the rights service users are entitled to and also training has increased which is good. Care Homes for Older People Page 25 of 30 Evidence: The shortfalls identified in this report once again highlight the need for management stability and continuous leadership in order for the home to be managed in the best interests of the people living there. Records and care practices need to be monitored to make sure the required standard is met. Once the manager has identified the shortfalls, he needs to show how these areas will be developed and improved. We looked at some of the accidents/incidents that had occurred in the home. There was no evidence to show that an audit of these was being carried out to establish if anything could be done differently to reduce the risk of these types of incidents recurring. The manager stated he would be addressing this, to look at the type, time and to update peoples risk assessments. A quality assurance survey has not been sent out since the last key inspection and the manager stated he planned to send out a survey to professionals. In order to make sure the service is run in the best interests of the people using the service, it is recommended a system is developed to gain the views of people who use the service and other professionals. We were told the home owner visits the home on a regular basis and meets with people to give them an opportunity to discuss any matters of concern. A sample of maintenance records showed safety checks were being carried out. A requirement was made at the last inspection for the staff to attend regular fire drills and fire safety training so they would know the action to take in the event of a fire this has been addressed. The service have a policy in place for the management and security of money belonging to people who use the service. A system was in place to show how peoples money was managed. The information provided in the AQAA was detailed and provided us with information about the service. The Commission are notified under Regulation 37 of the Care Homes regulations of notifiable incidents/accidents that have taken place in the home. 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 7 17 You must make sure that 24/06/2010 records are kept up to date and are accurately recorded. This is to ensure the information provided is accurate and up to date to reflect changes in a persons health care needs. 2 9 12 All medication must be administered/used only as prescribed. This is to safeguard the health and well being of people who use this service. 09/07/2010 3 9 24 There must be a system for 09/07/2010 regualrly auditing (checking) the standard of handling and recording medication within the service. This is to make sure standards can be monitored and improved where necessary. Care Homes for Older People Page 28 of 30 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 4 27 18 The registered person must 11/06/2010 make sure there are enough suitably qualified staff to meet peoples needs. This is to ensure there are enough staff available at all times to meet the health and social care needs of people livng in the home. 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 8 The records should include appropriate moving and handling risk assessments to ensure the risks to the person are minimised. Consideration should be given to using a body mapping tool to show any creams and lotions a person is prescribed and how these should be applied in order they can be applied correctly. Activities and social stimulation for people living at the home should continue to be addressed to ensure peoples social and recreational needs and interests are met. Consideration should be given to providing a sluicing disinfector to reduce the risk of cross infection. A recommendation was made that copies of original documents given as proof of identity be signed and dated to show that the originals have been seen. The manager and deputy need to audit and monitor records and care practices within the home to make sure the required standard is met. the manager needs to identify the shortfalls, show how this will be improved 2 9 3 12 4 5 26 29 6 33 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 30 of 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!

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