Care Home: Ryehill Country Lodge

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What the care home does well DS0000019721.V346376.R01.S.doc Version 5.2 Page 6The home continues to offer a very good standard of accommodation to the long term and respite residents and the environment is clean, hygienic and the atmosphere is friendly and welcoming. Five surveys from relatives stated that the home offers very good care and accommodation. They also stated how well the home was run, how clean it was and that the staff were excellent. Some comments included, "I visit my mum a lot and am always made to feel welcome and it`s like home from home", "everyone looks clean and tidy", "the home is generally well run and the staff caring and hard working". The ethos of the home is to maintain and promote independence and for the residents to be treated as individuals. Respect and dignity are a high priority for the manager and staff and this was confirmed by speaking to several people living in the home. From speaking to some of the people living in the home it was clear that they have good relationships with the staff, some comments included; "the staff are great", "the staff are lovely and Tina is wonderful", "the staff are so kind and helpful", "the staff are lovely all of them". People`s needs are fully assessed prior to admission so the individual and the home can be sure the placement is appropriate. People living in the home receive a statement of purpose and service user guide and these clearly describe what services and support they can expect to receive. Prospective residents are enabled to visit and sample the home prior to moving in on a permanent basis and this ensures that they are making an informed choice whether to live there. From observation and from speaking to the people who live in the home it was apparent that overall choice and independence are promoted and the residents are enabled to make their own decisions about everyday life within the home. People who use the service have a care plan that fully describes their needs and what support is required. There are risk assessments in place and these cover individual risks including pressure sores, bathing, using the stair lift, mobility and falls. These are basic, but do give a clear idea about what the risk is and how this is to be managed. People who use the service receive a good level of personal and healthcare support that ensures their needs are met. A range of recreational activities takes place within the home and community and individual preferences are accommodated. Therefore daily choice for residents and contact with friends, local community is encouraged and promoted. DS0000019721.V346376.R01.S.doc Version 5.2 Page 7From speaking to people living in the home and two relatives, also from information received in surveys from relatives it was confirmed that visitors are made very welcome and they can visit at any reasonable time. Comments included, "It doesn`t matter what time I come I am always made to feel welcome", "the staff always offer me a cup of tea and sometimes lunch", "the staff are very friendly and polite". People living in the home are supported in maintaining relationships both inside and outside of the home. People living in the home confirmed that they are consulted about the content of the menu. The menu is nutritious and wholesome. Some comments from residents and relatives included; "the food is excellent, I love it here", "I have enjoyed it and I have had two lots", "the food is lovely", "the food is great", "it is always good". The home has a complaints procedure in place that is open and accessible to people who use the service or their representatives; therefore the all complaints are dealt with in an open and fair way. The home has policies, procedures and staff receive training in relation to safeguarding adults, and therefore people who live in the home are protected from abuse. The home is warm, comfortable and well maintained. It is clean and hygienic, there are infection control procedures in place and staff have received training in this area. This ensures that the home is maintained to a good standard and people live in a safe, homely and comfortable environment. The home does have a training plan and evidence was seen confirming that on the whole the staff team has access to a range of training including the mandatory aspects of health and safety, first aid, safeguarding, moving and handling, infection control and fire safety. People live in a well run home, there is clear leadership and an open door policy ensures that residents are able to speak to the manager on a regular basis. The home has a very good quality assurance system that seeks the views of the people living in the home and any other interested party including family, health and social care professionals. People living the home have their money and financial interests are safeguarded and written transactions are maintained.Overall the health and safety of the residents is ensured by having all of the appropriate maintenance certificates in place, regular checks on these take place and evidence was seen confirming this. What has improved since the last inspection? The environment has been improved since the last inspection visit and the manager explained that the home applied for and was awarded a grant from East Riding Council and this has been used in refurbishing the ground floor bathroom. A new bath has been purchased and this has an electronic assisted seat fitted, it also has thermostatic to regulate the temperate and a shower utensil. The manager said, "this has helped greatly with the people who have limited mobility and also for the staff as it is much easier to move and assist people", "the toilet is automatic, it washes and dries the person and we have found that this can be helpful for infections". The bathroom has been re-tiled and a new floor fitted. The upstairs bathroom is due to be refurbished on 10.1.08 and is having a new bath, toilet and sink; also tiles and flooring will be renewed. Ten of the 15 staff members or 75% have achieved NVQ level 2 or above and this means that the home has exceeded the required 50%. A further three staff members are working towards obtaining NVQ level 2. What the care home could do better: The medication procedure is adhered to and staff have been appropriately trained, however the stock held in the home did not always match what was recorded. A system should be in place to record all medication received in to the home and medication carried over from the previous month. This helps to confirm that medication is being given as prescribed and when checking stock levels. There were one or two gaps in recording that could not be explained. The manager has the responsibility for ordering and booking in the medication was spoken to confirming that the order for prescriptions is sent straight to the pharmacist and then dispensed direct from the GP`s surgery to the home. However, the prescriptions are not sent to the home before the supply is made. Staff are not employed in sufficient numbers to ensure that people who live in the home have their needs fully met, as sometimes people have to wait forlong periods to receive care and support. This was confirmed by speaking to people living in the home and relatives and also from surveys received from staff members. The home has a recruitment procedure and from discussion with the manager it became apparent that until recently staff have commenced work with a POVA 1st check and prior to the Criminal Records Bureau check being received by the home. Three personnel files for staff were looked at confirming that the last two people to commence employment did so without the full Criminal Records Bureau check being in place. The manager stated, "I didn`t realise until recently that we had to wait for the Criminal Records Bureau before the person started work. I will adhere to this in the future". It was explained to the manager that the guidance is clear and staff must have a Criminal Records Bureau check in place prior to employment commencing and only in exceptional circumstances and following discussion with the CSCI and an agreement reached that staff may commence duties with a POVA 1st check, providing a mentor is in place and regular supervision, also that the staff member does not undertake any personal care tasks until the full Criminal Records Bureau has been received. Staff have commenced employment prior to the full Criminal Records Bureau check being in place, therefore people receive support from staff who may not have been properly vetted and therefore the protection and safety of the residents maybe compromised. The home does not currently offer an induction programme that meets the Skills for Care specification and this is an area that requires development as the home must ensure that the induction and foundation training is implemented immediately as this would make sure that people living in the home receive support from a well-trained, experienced and knowledgeable staff team who fully understands the needs of those living in the home. Supervision is offered to all staff, however this is not always on a regular basis. This would ensure that people using the service receive care from staff who are properly supervised and monitored. CARE HOMES FOR OLDER PEOPLE Ryehill Country Lodge Pitt Lane Ryehill Thorngumbald East Yorkshire HU12 9NN Lead Inspector Angela Sizer Unannounced Inspection 09:30 8 January 2008 th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address DS0000019721.V346376.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. DS0000019721.V346376.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ryehill Country Lodge Address Pitt Lane Ryehill Thorngumbald East Yorkshire HU12 9NN 01964 624245 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Arthur Bunting Mrs Tina Jane Bunting Care Home 23 Category(ies) of Dementia - over 65 years of age (23), Old age, registration, with number not falling within any other category (23) of places DS0000019721.V346376.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 3rd August 2006 Brief Description of the Service: Ryehill Country Lodge is located in the small village of Ryehill, which is approximately 4 miles from the market town of Hedon. The home is on a quiet country lane and there is no immediate access to public transport. The home has been registered since 1990 and provides personal care and accommodation for 23 older people who may have dementia. The home consists of a traditional two-storey country house, which has been extended providing further bedrooms and a laundry. The home has six double bedrooms and 11 single rooms over the two storeys, all of which are en-suite. The upstairs is accessed by a chair lift. There are 2 communal bathrooms; both have assisted baths available. There is a garden area to the front of the building, which is accessible to service users and includes chairs, tables and benches. Fees £334.80 - £381.30. DS0000019721.V346376.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means that the people who use this service experience good quality outcomes. This visit was an unannounced key inspection and took place over one day and took a total of 7 hours. Prior to the visit surveys were posted out to people living in the home, their representatives and social and healthcare professionals; 4 residents surveys, 5 of the relatives surveys and 4 staff members surveys were returned, none of the health and social care professionals or care manager surveys were returned. The Annual Quality Assurance Assessment was completed and returned to the CSCI (Commission for Social Care Inspection). The previous recommendation was discussed with the manager and it was confirmed that this has been met. A discussion occurred regarding how the people living in the home are supported to follow their religion of choice and practise their faith and how the home meets diverse needs of individuals. The majority of the people living in Ryehill were spoken to throughout the day regarding the care they receive and what it is like to live in the home, some of their comments have been included in this report. Three files containing the care records of people living in the home were tracked during the site visit and three staff personnel files were looked at. A tour of the premises was undertaken and a number of records were looked at to ensure that the correct maintenance has been undertaken. The manager was given feedback during and at the end of the visit. The inspector would like to thank the people living in the home, manager and staff for welcoming her into the home and contributing to the content of this report. What the service does well: DS0000019721.V346376.R01.S.doc Version 5.2 Page 6 The home continues to offer a very good standard of accommodation to the long term and respite residents and the environment is clean, hygienic and the atmosphere is friendly and welcoming. Five surveys from relatives stated that the home offers very good care and accommodation. They also stated how well the home was run, how clean it was and that the staff were excellent. Some comments included, “I visit my mum a lot and am always made to feel welcome and it’s like home from home”, “everyone looks clean and tidy”, “the home is generally well run and the staff caring and hard working”. The ethos of the home is to maintain and promote independence and for the residents to be treated as individuals. Respect and dignity are a high priority for the manager and staff and this was confirmed by speaking to several people living in the home. From speaking to some of the people living in the home it was clear that they have good relationships with the staff, some comments included; “the staff are great”, “the staff are lovely and Tina is wonderful”, “the staff are so kind and helpful”, “the staff are lovely all of them”. People’s needs are fully assessed prior to admission so the individual and the home can be sure the placement is appropriate. People living in the home receive a statement of purpose and service user guide and these clearly describe what services and support they can expect to receive. Prospective residents are enabled to visit and sample the home prior to moving in on a permanent basis and this ensures that they are making an informed choice whether to live there. From observation and from speaking to the people who live in the home it was apparent that overall choice and independence are promoted and the residents are enabled to make their own decisions about everyday life within the home. People who use the service have a care plan that fully describes their needs and what support is required. There are risk assessments in place and these cover individual risks including pressure sores, bathing, using the stair lift, mobility and falls. These are basic, but do give a clear idea about what the risk is and how this is to be managed. People who use the service receive a good level of personal and healthcare support that ensures their needs are met. A range of recreational activities takes place within the home and community and individual preferences are accommodated. Therefore daily choice for residents and contact with friends, local community is encouraged and promoted. DS0000019721.V346376.R01.S.doc Version 5.2 Page 7 From speaking to people living in the home and two relatives, also from information received in surveys from relatives it was confirmed that visitors are made very welcome and they can visit at any reasonable time. Comments included, “It doesn’t matter what time I come I am always made to feel welcome”, “the staff always offer me a cup of tea and sometimes lunch”, “the staff are very friendly and polite”. People living in the home are supported in maintaining relationships both inside and outside of the home. People living in the home confirmed that they are consulted about the content of the menu. The menu is nutritious and wholesome. Some comments from residents and relatives included; “the food is excellent, I love it here”, “I have enjoyed it and I have had two lots”, “the food is lovely”, “the food is great”, “it is always good”. The home has a complaints procedure in place that is open and accessible to people who use the service or their representatives; therefore the all complaints are dealt with in an open and fair way. The home has policies, procedures and staff receive training in relation to safeguarding adults, and therefore people who live in the home are protected from abuse. The home is warm, comfortable and well maintained. It is clean and hygienic, there are infection control procedures in place and staff have received training in this area. This ensures that the home is maintained to a good standard and people live in a safe, homely and comfortable environment. The home does have a training plan and evidence was seen confirming that on the whole the staff team has access to a range of training including the mandatory aspects of health and safety, first aid, safeguarding, moving and handling, infection control and fire safety. People live in a well run home, there is clear leadership and an open door policy ensures that residents are able to speak to the manager on a regular basis. The home has a very good quality assurance system that seeks the views of the people living in the home and any other interested party including family, health and social care professionals. People living the home have their money and financial interests are safeguarded and written transactions are maintained. DS0000019721.V346376.R01.S.doc Version 5.2 Page 8 Overall the health and safety of the residents is ensured by having all of the appropriate maintenance certificates in place, regular checks on these take place and evidence was seen confirming this. What has improved since the last inspection? What they could do better: The medication procedure is adhered to and staff have been appropriately trained, however the stock held in the home did not always match what was recorded. A system should be in place to record all medication received in to the home and medication carried over from the previous month. This helps to confirm that medication is being given as prescribed and when checking stock levels. There were one or two gaps in recording that could not be explained. The manager has the responsibility for ordering and booking in the medication was spoken to confirming that the order for prescriptions is sent straight to the pharmacist and then dispensed direct from the GP’s surgery to the home. However, the prescriptions are not sent to the home before the supply is made. Staff are not employed in sufficient numbers to ensure that people who live in the home have their needs fully met, as sometimes people have to wait for DS0000019721.V346376.R01.S.doc Version 5.2 Page 9 long periods to receive care and support. This was confirmed by speaking to people living in the home and relatives and also from surveys received from staff members. The home has a recruitment procedure and from discussion with the manager it became apparent that until recently staff have commenced work with a POVA 1st check and prior to the Criminal Records Bureau check being received by the home. Three personnel files for staff were looked at confirming that the last two people to commence employment did so without the full Criminal Records Bureau check being in place. The manager stated, “I didn’t realise until recently that we had to wait for the Criminal Records Bureau before the person started work. I will adhere to this in the future”. It was explained to the manager that the guidance is clear and staff must have a Criminal Records Bureau check in place prior to employment commencing and only in exceptional circumstances and following discussion with the CSCI and an agreement reached that staff may commence duties with a POVA 1st check, providing a mentor is in place and regular supervision, also that the staff member does not undertake any personal care tasks until the full Criminal Records Bureau has been received. Staff have commenced employment prior to the full Criminal Records Bureau check being in place, therefore people receive support from staff who may not have been properly vetted and therefore the protection and safety of the residents maybe compromised. The home does not currently offer an induction programme that meets the Skills for Care specification and this is an area that requires development as the home must ensure that the induction and foundation training is implemented immediately as this would make sure that people living in the home receive support from a well-trained, experienced and knowledgeable staff team who fully understands the needs of those living in the home. Supervision is offered to all staff, however this is not always on a regular basis. This would ensure that people using the service receive care from staff who are properly supervised and monitored. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by DS0000019721.V346376.R01.S.doc Version 5.2 Page 10 contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. DS0000019721.V346376.R01.S.doc Version 5.2 Page 11 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000019721.V346376.R01.S.doc Version 5.2 Page 12 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3 & 5 People who use the service experience excellent outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People’s needs are fully assessed prior to admission so the individual and the home can be sure the placement is appropriate. EVIDENCE: From speaking to several people who live in the home and two relatives who were visiting it was apparent that the home clearly explains what they can expect from their stay and there was written evidence confirming this. The manager confirmed that since the last inspection that the statement of purpose has been further developed and is also available in a large print DS0000019721.V346376.R01.S.doc Version 5.2 Page 13 version. Some comments included; “I came to look around and loved it”, “my son came to Ryehill and knew I would like it”, “as soon as I saw it I wanted to move in”. During the inspection visit three files of people living in the home were looked at and there was evidence confirming that the permanent and respite residents have either a community care assessment or the home’s own assessment undertaken prior to or within a few days of admission. For people who privately fund their care there was evidence that the home undertakes a thorough assessment of their needs both prior to and following their admission. The home’s own assessment included personal care and wellbeing, weight, communication, oral health, foot care, mobility, falls, continence, medication, mental health, risk management and social interests. The manager confirmed that a visit to the prospective resident is undertaken prior to a place being offered. She said, “I or my assistant manager will visit the person and carry an assessment to ensure that we can meet their needs”, “the person and their families are always invited into the home at a convenient time to them and to have a look around and see what facilities there are here, they can stay for a meal while they visit”. A care plan is then drawn up detailing what action is to be carried out by the care staff, the home works with this document and this is reviewed on a monthly basis. There was evidence in place to confirm that regular reviews are undertaken, usually on a six monthly basis and the management also undertakes regular checks of the files. From speaking to several of the people living in the home and from information received from relatives and other professionals it was clear that they were fully involved in the assessment process and this was explained to them. All 4 surveys received from people living in the home prior to the inspection visit stated that information pack was given before admission and some comments included; “my family were given the information”, “yes I got a brochure with pictures in it”. DS0000019721.V346376.R01.S.doc Version 5.2 Page 14 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 & 10 People who use the service experience good outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People who use the service receive a good level of personal and healthcare support that ensures their needs are met. The medication procedure is adhered to and staff have been appropriately trained, however the stock held in the home did not always match what was recorded. A system should be in place to record all medication received in to the home and medication carried over from the previous month. This helps to confirm that medication is being given as prescribed and when checking stock levels. The prescriptions are not sent to the home before the supply is made. The person in charge of ordering medication should have sight of the prescriptions before a supply is made. The prescription is the authority for the staff to administer medication and this also provides an opportunity to check if any new medicines or dose changes are included. Staff treat people with respect and privacy is promoted within the home. DS0000019721.V346376.R01.S.doc Version 5.2 Page 15 EVIDENCE: During the inspection three files of people living in the home were looked at and each file contained a photograph of the resident, personal information and details of any specific need such as dietary, diabetic or other health or social care needs. The files are well organised into sections and it is easy to find information. All files contained an admission checklist and this identifies needs, medication, physical, emotional etc. The manager explained that from the community care assessment a care plan is developed for each person covering a variety of areas including; personal care and dressing, continence, mobility, eating and drinking, emotional, communication, leisure, social and cultural interests, night care and medical needs. These were very good and contained in-depth information that would give a clear idea of what the need is and how this would be met. Each person had information about their life, likes, dislikes and this gives staff a good idea about what life used to be like for that person before they came to live in the home. The home operates a key worker system and the photographs of the care staff are displayed in the entrance area of the home. From speaking to several people living in the home they were able to confirm whom their key worker was and that they could talk to that person if they wanted to. There was evidence in place confirming that regular reviews are undertaken and people living in the home are able to partake fully and express their views and this was confirmed by looking at the review paperwork and also from speaking to some of them. Some comments received included; “I visit my mum a lot and in always made welcome and its like home from home”, “everyone looks clean and it doesn’t smell”, “the care and staff are 100 you can’t beat that”. Written evidence was seen confirming that people living in the home receive regular healthcare checks for optical, chiropody, dental, nutritional screening is undertaken at the point of admission and residents’ are weighed on a monthly basis. The registered manager explained that this would be increased if a problem had been identified and appropriate professional advice would be DS0000019721.V346376.R01.S.doc Version 5.2 Page 16 sought. It was also confirmed by speaking to two relatives and several of the people living in the home that the home promotes and maintains health care and regular check ups are undertaken. One person said, “I have been very looked after and the District Nurse comes to see me as well”. A visiting Community Psychiatric Nurse was spoken to during the inspection and this confirmed that the home liaises well with other health care providers and ensures that information is recorded and any concerns are quickly passed on to the appropriate agency. Comments included; “the home always contacts me if there are any concerns about a resident”, “the manager is excellent in contacting us quickly and often prevents the person deteriorating”, “we work well as a team”. Funeral arrangements and religious/cultural beliefs are recorded and information sought confirming any specific requirements following the death of a resident. The manager did state that this was sometimes difficult to undertake. She said, “I do discuss this at the point of admission if possible, sometimes people can’t tell you or request that their family deal with it and then I would involve their family”. This shows that the home is thinking about diverse needs of individuals and is promoting equality within the service. There are risk assessments in place and these cover individual risk including pressure sores, bathing, using the stair lift, mobility and falls. These are basic, but do give a clear idea about what the risk is and how this is to be managed. The home has a medication policy and procedure. The medication system was observed and records looked at were in satisfactory order and on the whole staff follow the procedures correctly, however there were one or two gaps in recording that could not be explained. The manager has the responsibility for ordering and booking in the medication was spoken to confirming that the order for prescriptions is sent straight to the pharmacist and then dispensed direct from the GP’s surgery to the home. However, the prescriptions are not sent to the home before the supply is made. The person in charge of ordering medication should have sight of the prescriptions before a supply is made. The prescription is the authority for the staff to administer medication. This also provides an opportunity to check if any new medicines or dose changes are included. Any problems with prescriptions can be addressed at this point rather than after the supply has been made. The checking of prescriptions is an important part of the management of medication. The quantity of medication from one monthly cycle to another is not recorded on the new MAR. Therefore the quantity on the MAR chart did not include all DS0000019721.V346376.R01.S.doc Version 5.2 Page 17 the stock being stored. This means it is difficult to have a complete record of medication within the home and to check if medication is being administered correctly. The home takes people for respite care and because their medication is brought in with them there is no Medication Administration Record sent from the Pharmacist. The home transcribes the prescription onto a Medication Administration Record, but currently does not obtain two staff signatures. A witness signature is good practice to ensure that the content of the MAR entry is accurate and this would be seen as good practice. From speaking to the Assistant Manager who was administering the medication, it was clear that only staff who have undertaken the training offered by Beverley College administer medication. The majority of the medication is stored in a medication trolley and when not in use this is secured to the wall in the lounge/dining room. The home has a procedure for the use of controlled drugs and storage space within a metal medication cabinet; currently there are none in use. There is a controlled drugs register, two staff always signs when administering the controlled medication. There is a refrigerator for medication only and the temperature is recorded on a regular basis. The home undertakes a risk assessment with each resident with regard to self-administration and written evidence confirming this was seen. The home returns all refused medication, it is placed in an envelope with the residents’ name, what the medication is and the dosage and is returned to the Pharmacist at the end of the month. From speaking to several residents it was confirmed that the staff treat people with respect and are courteous at all times and also maintaining privacy and dignity at all times. Some comments included; “the staff are great, I wouldn’t want to be anywhere else”, “ they are wonderful, 100 satisfied”, “I cannot fault it”, “I am very happy here”, “staff are very respectful and courteous”. DS0000019721.V346376.R01.S.doc Version 5.2 Page 18 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 & 15 People who use the service experience good outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. A range of recreational activities takes place within the home and community and individual preferences are accommodated. Therefore daily choice for residents and contact with friends, local community is encouraged and promoted. The menu offered is varied and nutritious this ensures that people who live in the home received a healthy diet. EVIDENCE: A discussion with the manager took place confirming that the level of activity has been maintained since the last inspection. From speaking to several DS0000019721.V346376.R01.S.doc Version 5.2 Page 19 people living in the home it was confirmed that the level of activities offered is good and these include Bingo, playing games, having a singsong, baking and trips out on a regular basis. Some comments included; “yes we have activities, bingo and we go out sometimes in the bus”, “Bingo every week, we play for prizes”. The manager stated that the assistant manager also undertakes baking with residents on an individual basis and this is to promote independence and social skills. The home has a volunteer who attends twice a week to run the Bingo. The home has it’s own mini-bus and people go out in it on a regular basis. From speaking to people living in the home and two relatives, also from information received in surveys from relatives it was confirmed that visitors are made very welcome and they can visit at any reasonable time. Comments included, “It doesn’t matter what time I come I am always made to feel welcome”, “the staff always offer me a cup of tea and sometimes lunch”, “the staff are very friendly and polite”. People living in the home are supported in maintaining relationships both inside and outside of the home. During the visit staff were observed attending to people living in the home and this was carried out in a caring and sensitive way. At lunch time several people required assistance with eating and again this was undertaken at the person’s pace, it was not rushed and the staff throughout were professional and understanding. Some comments from people living in the home included; “”this home is 100 , I have no complaints and the staff are lovely and Tina is wonderful”, “the care is second to none and it couldn’t be any better”, “the staff are so kind and helpful”, “I have been very well looked after”, “the staff are great, all of them”. Residents were observed to be individual in their style of dress. The atmosphere was relaxed, warm and homely. Overall the evidence seen and information gained from residents, relatives and the manager confirmed that social contact and activities are promoted. Residents enjoy a varied activity programme and take part in outings and external activities on a regular basis. Community contact is maintained and several of the residents attend a local community centre, others go out for pub lunches or enjoy a walk with a member of staff. People living in the home confirmed that staff ask what time they want to get up and when they want to retire to bed or if where they would like to eat etc. The home employs a male carer and this enables male residents to choose to have care provided by a carer of their own gender, increasing their choices. DS0000019721.V346376.R01.S.doc Version 5.2 Page 20 The home has a Key worker system in place that works well. Also people living in the home were observed to be individual and wore clothes of their own choice, from speaking to several of them it was clear that they were able to make decisions about everyday life within the home. The home operates a four-week rotating menu and this is displayed on the dining tables. The manager explained that she and the staff felt it was important to develop information in the event of a resident being admitted who had diverse needs due to their beliefs or culture. Lunch was observed and consisted cottage pie, carrots and peas or there was an alternative vegetarian dish, dessert was sponge and custard or blancmange, it was very well presented, plentiful and looked appealing to the eye. People living in the home confirmed that they are consulted about the content of the menu. The menu is nutritious and wholesome. Some comments from residents and relatives included; “the food is excellent, I love it here”, “I have enjoyed it and I have had two lots”, “the food is lovely”, “the food is great”, “it is always good”. The home employs 2 part time cooks and they have an up to date food hygiene certificate. There are no outstanding requirements from the Environmental Health Department. Drinks are available throughout the day and evening. There is a breakfast area in the main lounge/dining room and some of the people living in the home are able to make their own drinks. Relatives also confirmed that they could make themselves a drink if they want to. There is a fresh water dispenser situated in the lounge too. DS0000019721.V346376.R01.S.doc Version 5.2 Page 21 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,17 & 18 People who use the service experience good outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. The home has a complaints procedure in place that is open and accessible to people who use the service or their representatives; therefore the all complaints are dealt with in an open and fair way. The home has policies, procedures and staff receive training in relation to safeguarding adults, and therefore people who live in the home are protected from abuse. EVIDENCE: The home has a robust complaint policy and procedure. There have been three complaints since the last inspection and written evidence was seen confirming that these had been dealt with appropriately and quickly. The manager stated that she investigates the complaints and responds to the complainant. During the inspection some of the people who live in the home were spoken to about the complaints procedure and it was evident that they were aware of whom to DS0000019721.V346376.R01.S.doc Version 5.2 Page 22 complain to. Two relatives were also spoken to during the visit and they too could confirm that if they had a problem it was sorted out, “quickly and efficiently”, “the manager is very approachable and listens to any problems”. Four of the five surveys received from relatives confirmed that they were aware of the complaints procedure and from speaking to residents it was clear that they were confident that if they had the need to complain that this would be listened to and taken seriously. The home has a multi-agency policy and procedure for the prevention of abuse and all staff has undertaken the training. There have been no safeguarding issues since the previous inspection visit. From discussion with the manager it was clear that she had a very good understanding of the protection of vulnerable adults procedure and how and when this must be implemented, in order to protect the people living in the home from abuse. The home maintains records for the personal finances of residents. The records were checked and were found to be in order and up to date. There is a staff signature for every transaction; receipts are kept with the documentation. Some individuals have their own individual bank accounts and several of the residents’ families take care of their finances. DS0000019721.V346376.R01.S.doc Version 5.2 Page 23 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,21,24 & 26 People who use the service experience good outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. The home is warm, comfortable and well maintained. It is clean and hygienic, there are infection control procedures in place and staff have received training in this area. This ensures that the home is maintained to a good standard and people live in a safe, homely and comfortable environment. EVIDENCE: A tour of the building was undertaken confirming that the previous high standards of cleanliness have been maintained. Overall the standard of the environment is very good. No offensive smells were detected during the visit. DS0000019721.V346376.R01.S.doc Version 5.2 Page 24 The home has a laundry room on the ground floor containing two industrial washing machines and one industrial dryer, there is a further industrial dryer located in an outside shed. There are good infection control procedures in place, all staff have received training in this area and this ensures that disease and illness are managed in a safe way and residents receive the support they require without being placed at risk of contracting infectious diseases. The home has a alcohol gel dispenser fixed to the front door to ensure that all visitors adhere to the infection control procedure and reduce the risk of infection occurring. Several of the residents spoke about their rooms and how much they enjoyed living in the home and some comments included; “my room is lovely”, “I have all my belongings with me”, “there is nothing to be improved”. Surveys returned from relatives indicated that the home was very clean and hygienic. Surveys from residents also commented about the cleanliness of the home and some of these were; “everyone looks clean and it doesn’t smell”, “I visit my mum a lot and I am always made welcome and it’s like home from home”. A discussion with the manager occurred in relation to the smoking legislation that came into effect from 1.07.07. The manager explained that a decision was made to make the home a ‘no smoking’ home and this is made clear in the statement of purpose. All of the water outlets have regulators fitted ensuring that the hot water distributes at a safe temperature. Several of the outlets were checked during the visit and found to be acceptable. The home has sufficient toilets and bathrooms in order to meet residents’ needs. All toilets and bathrooms are clearly signposted. The manager explained that since the last inspection the home applied for and was awarded a grant from East Riding Council and this has been used in refurbishing the ground floor bathroom. A new bath has been purchased and this has an electronic assisted seat fitted, it also has thermostatic to regulate the temperate and a shower utensil. The manager said, “this has helped greatly with the people who have limited mobility and also for the staff as it is much easier to move and assist people”, “the toilet is automatic, it washes and dries the person and we have found that this can be helpful for infections”. The bathroom has been re-tiled and a new floor fitted. The upstairs bathroom is due to be refurbished on 10.1.08 and is having a new bath, toilet and sink; also tiles and flooring will be renewed. DS0000019721.V346376.R01.S.doc Version 5.2 Page 25 Overall the general condition of the home and its facilities is very good. There is a maintenance plan and work is prioritised. The manager said that although she doesn’t have a separate fund for maintenance, the Registered Providers always provide the financial support that is requested. Individual bedrooms are nicely decorated and personalised with their belongings including pictures, teddies, books, TV, photographs etc. From speaking to some of the people who live in the home it was obvious that they enjoy living in the home and feel that the standard of accommodation is very good. DS0000019721.V346376.R01.S.doc Version 5.2 Page 26 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 & 30 People who use the service experience adequate outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. Staff are not employed in sufficient numbers to ensure that people who live in the home have their needs fully met, as sometimes people have to wait for long periods to receive care and support. People receive support from staff who may not have been properly vetted and therefore the protection and safety of the residents maybe compromised. Overall, people who live in the home receive support from a well-trained and experienced staff group. However, not all staff updated some of the mandatory or skills for care induction training and therefore the health and safety of residents could be compromised. EVIDENCE: DS0000019721.V346376.R01.S.doc Version 5.2 Page 27 The home has a varied staff group in age and experience, one male carer is employed and this offers the opportunity for male residents to receive care from a person of the same sex. Currently the home has a staff team of 15 carers and a total 406 care hours per week. There are two carers on duty throughout the day and night, and three carers at busier periods between 4pm and 8pm. The home employs two part-time cooks and domestic staff for six hours per day and the manager explained that the domestic staff have undertaken mandatory training such as health and safety, infection control, moving and handling, first aid, fire safety to enable them to help out at busy times with care duties. In addition to the 23 permanent residents the home also offers support for up to four-day care places. The residential forum states that for the current amount of people living in the home there should be a minimum of 509.97 care hours per week. This is without taking into account the needs of the four-day care placements. The home has applied to increase it’s registration to 24 places and this is currently being processed by the CSCI, but the additional place will increase the number of care hours required. From speaking to a visiting relative it was evident that this has been raised as a concern with the management previously and some comments made included, “the home is excellent other than the staffing levels, people have to wait for carers to go to the toilet”, “my concern is that these people cannot always wait”, “I would like to see more carers on duty, “I have discussed this with Tina and she knows how I feel about it”. One survey from a person living in the home and one from a relative also commented that the staffing levels are not always sufficient and people have to wait to be attended to. Therefore currently the home does not provide sufficient numbers of staff in order to fully meet the needs of the people living in the home. Ten of the 15 staff members or 75 have achieved NVQ level 2 or above and this means that the home has exceeded the required 50 . A further three staff members are working towards obtaining NVQ level 2. The home has a recruitment procedure and from discussion with the manager it became apparent that until recently staff have commenced work with a POVA 1st check and prior to the Criminal Records Bureau check being received by the home. Three personnel files for staff were looked at confirming that the last two people to commence employment did so without the full Criminal Records Bureau check being in place. The manager stated, “I didn’t realise until recently that we had to wait for the Criminal Records Bureau before the person started work. The last person to start work had a full disclosure in place and I will adhere to this in the future”. It was explained to the manager that the guidance is clear and staff must have a Criminal Records Bureau check in place DS0000019721.V346376.R01.S.doc Version 5.2 Page 28 prior to employment commencing and only in exceptional circumstances and following discussion with the CSCI and an agreement reached that staff may commence duties with a POVA 1st check, providing a mentor is in place and regular supervision, also that the staff member does not undertake any personal care tasks until the full Criminal Records Bureau has been received. The home does have a training plan and evidence was seen confirming that on the whole the staff team has access to a range of training including the mandatory aspects of health and safety, first aid, safeguarding, moving and handling, infection control and fire safety. Three files were looked at to ensure these were up to date, two of the three staff members had undertaken all of the mandatory training, one person who commenced employment in October 07 had not undertaken either induction or foundation training. The manager said, “we have an in-house induction programme, but we are currently changing over to the Skills for Care induction training and all new starters will do this training from now on”. Unfortunately there was no written evidence to confirm that the person who commenced employment in October 2007 had undertaken the home’s own induction programme nor was their evidence that that person had undertaken any of the mandatory training. This is an area that requires development as the home must ensure that the induction and foundation training is implemented immediately as this would make sure that people living in the home receive support from a well-trained, experienced and knowledgeable staff team who fully understands the needs of those living in the home. DS0000019721.V346376.R01.S.doc Version 5.2 Page 29 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,36 & 38 People who use the service experience good outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People live in a well run home, there is clear leadership and an open door policy ensures that residents are able to speak to the manager on a regular basis. The home has a very good quality assurance system that seeks the views of the people living in the home and any other interested party including family, health and social care professionals. People living the home have their money and financial interests are safeguarded and written transactions are maintained. Supervision is offered to all staff, however this is not always on a regular basis. DS0000019721.V346376.R01.S.doc Version 5.2 Page 30 This would ensure that people using the service receive care from staff who are properly supervised and monitored. Overall the health, safety and welfare of residents and staff are promoted and protected. EVIDENCE: The registered manager has many years experience in care field and she has achieved NVQ level 4 in both care and management. She confirmed that she has worked at Ryehill for 7.5 years and has been the manager for the past 2.5 years. Since the last inspection the manager stated that she had undertaken refresher training in relation to fire safety, moving and assisting, mental capacity, health and safety. She has also undertaken a further management course that was completed in August 2007. From observation it was evident that the manager is approachable and welcomes people either living or visiting into her office. Both residents and staff requested help and support from the manger during the visit and this was given in a supportive and caring way. Some comments included; “she is approachable and friendly”, “I can discuss any issues I may have as the manageress is very approachable”, “Tina is wonderful”. During the inspection visit the quality assurance system was looked at confirming that surveys are given out to people who live in the home on a monthly basis. Other surveys are forwarded to relatives, GP’s, social workers, district nurses on a yearly basis. The information is collated twice yearly and the results are currently shared with the people living in the home, but not with the CSCI. The manager said, “I am going to prepare an annual report and collate all of this information, this will be shared with the residents and others involved. This will be done within the next two weeks”. The home has achieved Parts 1 & 2 of the Local Authorities Quality Development Scheme and the one recommendation from their last visit was for regular staff meetings and an agenda has been met. The home has financial policies and procedures to ensure that people who live there have their financial interests safeguarded. Written records were checked DS0000019721.V346376.R01.S.doc Version 5.2 Page 31 that detailed the personal allowances for individuals these were up to date and correct. Supervision is offered to all staff, but for some of the staff it is not as regular as is recommended in the national minimum standards. Since the last inspection the Fire Department has visited the home and made a requirement for a number of fire doors to be upgraded to include cold smoke seals. During the visit written evidence was seen that the Fire Department visited in November 2007 stating that “good progress had been made”. The manager said, “the Fire Officer is coming back on 10.1.08 to check compliance has been fully achieved”. The fire risk assessment has been updated and approved by the Fire Department since the last inspection. All staff receive annual fire safety training and the fire alarm and equipment are checked and maintained. The generic and individual risk assessments have been reviewed. These give clear direction to staff and explain how to manage the risk. During the visit it was confirmed from speaking to the manager and people living in the home, also from looking at written evidence that the home offers a range of support to people with diverse needs. Some staff have undertaken training in Dementia care, challenging behaviour, MRSA and incontinence care. The manager stated that she and the staff group will be attending equality and diversity training within the next few months. Currently there are no residents who have a different culture. Religious beliefs are fully supported and in conversation with people living in the home, relatives and from surveys received this was confirmed. The home has developed a varied menu that includes a vegetarian option. The manager also said, “if a person came into the home of a different religion or culture, we would research and seek information to ensure that we could provide them with the appropriate care and foods appropriate to them”. This shows that the home is developing in terms of offering a service to the wider community ensuring that certain individuals or groups are not excluded Overall the health and safety of the residents is ensured by having all of the appropriate maintenance certificates in place, regular checks on these take place and evidence was seen confirming this. DS0000019721.V346376.R01.S.doc Version 5.2 Page 32 DS0000019721.V346376.R01.S.doc Version 5.2 Page 33 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X 4 N/a HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 X 3 X X 3 X 4 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 4 3 X 3 2 X 3 DS0000019721.V346376.R01.S.doc Version 5.2 Page 34 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP27 Regulation 18 Requirement Sometimes people have to wait for long periods to receive care and support, therefore currently the home does not provide sufficient numbers of staff in order to fully meet the needs of the people living in the home. People who live in the home must be supported by a safe recruitment procedure, all new employees must have a Criminal Records Bureau in place prior to being employed or having any contact with people who live in the home, this will ensure that staff have been checked out properly prior to being employed and the safety of the residents is not compromised. All staff must receive induction and foundation training that meets the Skills for Care specification, this would ensure that they have the necessary DS0000019721.V346376.R01.S.doc Timescale for action 08/04/08 2 OP29 19 Schedule 2 08/04/08 3 OP30 18 08/04/08 Version 5.2 Page 35 3 OP36 18 5 OP38 17,18 skills and knowledge to care for the people living in the home. All staff who undertake care duties must receive formal supervision of a minimum of six times per year. This will ensure that people who live in the home receive care from a wellsupported staff group whose practice is monitored on a regular basis. As stated in Standard 30, the home’s induction programme does not meet the Skills for Care specification and must be implemented, this would ensure that people living in the home receive support from a welltrained staff group. 08/04/08 08/04/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP9 Good Practice Recommendations Medication in use and in date should be carried forward and recorded onto the Medication Administration Record as this would ensure there was an accurate record of current medication stock. The person who has ordered the medication should have sight of the prescriptions before they are dispensed, this provides an opportunity to check if any new medicines or dose changes are included. When the home transcribes onto a Medication Administration Record a witness signature should be gained and would ensure that the content of the MAR entry is accurate and this would be seen as good practice. 2 OP9 3 OP9 DS0000019721.V346376.R01.S.doc Version 5.2 Page 36 DS0000019721.V346376.R01.S.doc Version 5.2 Page 37 Commission for Social Care Inspection Hessle Area Office First Floor, Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI DS0000019721.V346376.R01.S.doc Version 5.2 Page 38 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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