Care Home: Ryelands

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What the care home does well Staff have developed good relationships with people who use the service and visitors. People who use the service made positive comments on the approach and attitude of staff. Staff were described as "good", "kind" and "very helpful" Visitors felt welcome in the home and expressed confidence in the staff group to keep them informed of any issues. We observed staff providing support to individuals in a sensitive and caring manner. People who use the service told us they felt "safe here". People who use the service expressed real satisfaction with their rooms. Individual rooms are of a good size and fitted with a kitchen area and en suite facilities. The service encourages people to personalise their room with their own furniture and belongings. Many people who use the service find the support and services of the Chaplain an important and positive part of their lives. Staff are developing good assessments and person centred support plans. These documents are written from the view point of the person using the service which can assist staff in recognising the individual person. What has improved since the last inspection? Staff files now include details of the checks carried out by the organisation before they start work in the home. This assists in ensuring the safety of people who use the service. Improvements have been made in making sure that support plans are up to date and person centred which assists in ensuring that people receive the support they need in the way they wish. The frequency of staff meetings and supervision has improved which helps staff to keep up to date with any changes and provides them with more support in their role. Risk assessments have been improved which assists in protecting people who use the service and supporting people to take assessed risks. Mealtimes are better managed which assists in making meals a more social event. The management of medication has improved which protects the health of people who use the service. CARE HOMES FOR OLDER PEOPLE Ryelands 15 Beddington Gardens Wallington Surrey SM6 0JF Lead Inspector Liz O`Reilly Key Unannounced Inspection 8th July 2008 10:30 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 Ryelands DS0000007194.V367140.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. Ryelands DS0000007194.V367140.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ryelands Address 15 Beddington Gardens Wallington Surrey SM6 0JF 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) 020 8647 6837 020 8254 7047 home.wal@mha.org.uk home.fxg@mha.org.uk Methodist Homes for the Aged Vacant Care Home 48 Category(ies) of Old age, not falling within any other category registration, with number (48) of places Ryelands DS0000007194.V367140.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home Only (CRH - PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is: 48 10th July 2007 Date of last inspection Brief Description of the Service: Ryelands is owned by a voluntary organisation ‘Methodist Homes for the Aged’ and is situated a short distance from Wallington town centre. The home is open to all regardless of gender, race, financial position or religious faith. The home is registered to provide care to 48 older people sixteen of whom need dementia care. The site includes Ryelands a care home for older people and Brooklands a separate unit for people living with dementia. For the purpose of this inspection report both units are referred to as Ryelands. A block of supported independent living flats, Moorlands are part of the complex. The garden at Ryelands is shared with Moorlands. All service users’ rooms have en-suite facilities and a kitchen area. There is a lift serving all floors. The scale of charges is £551-£669 per week. Ryelands DS0000007194.V367140.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 two stars. This means people who use this service experience good quality outcomes. This unannounced inspection was carried out by two regulation inspectors over one day. We spoke to eleven people who use the service, ten staff, the Chaplain and three visitors to the service. Surveys were sent to people who use the service and staff. We received three completed surveys from people who use the service. The manager completed their own assessment of the service (AQAA) for the Commission. We have used information from all of the above sources as well as our observations on the day to reach the judgements set out in this report. What the service does well: What has improved since the last inspection? Staff files now include details of the checks carried out by the organisation before they start work in the home. This assists in ensuring the safety of people who use the service. Ryelands DS0000007194.V367140.R01.S.doc Version 5.2 Page 6 Improvements have been made in making sure that support plans are up to date and person centred which assists in ensuring that people receive the support they need in the way they wish. The frequency of staff meetings and supervision has improved which helps staff to keep up to date with any changes and provides them with more support in their role. Risk assessments have been improved which assists in protecting people who use the service and supporting people to take assessed risks. Mealtimes are better managed which assists in making meals a more social event. The management of medication has improved which protects the health of people who use the service. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Ryelands DS0000007194.V367140.R01.S.doc Version 5.2 Page 7 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 Ryelands DS0000007194.V367140.R01.S.doc Version 5.2 Page 8 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 & 6 People who use this service experience good quality outcomes in these areas. This judgement has been made using available evidence including a visit to this service. Information is provided for prospective service users through the Service User Guide. People are encouraged to visit the service before making any decision about moving in. Admissions only take place if the service is confident staff have the skills and ability to meet individual assessed needs. EVIDENCE: People who use the service told us that they had been given enough information to make an informed decision about moving in. One person said they had chosen to move in because they felt “it was right” for them. Another person told us they had made the decision after visiting the service. The manager informed us through their assessment that arrangements can be made for individuals to have a short stay in the service to see if this is the place for them. Ryelands DS0000007194.V367140.R01.S.doc Version 5.2 Page 9 A Service User Guide gives information about what people can expect and includes the results from surveys of people already living at the service. We looked at a sample of files and found good pre admission assessments had been carried out for each individual. These assessments assist in setting up initial support plans and ensure that staff have some knowledge of the individual needs and preferences of a person before they move in. Assessments are written in the first person which assists in providing a person centred service. Over next twelve months the service plans to review the equal opportunities strategy to assist in ensuring the service is accessible and attractive to older people from minority ethnic communities This service does not provide intermediate care. Ryelands DS0000007194.V367140.R01.S.doc Version 5.2 Page 10 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 this service experience good quality outcomes in these areas. This judgement has been made using available evidence including a visit to this service. Staff are making progress in developing person centred care planning. The health care needs of people who use the service are met and medication is well managed. Staff respect the privacy and dignity of individuals and are sensitive to changing needs. EVIDENCE: Each person is provided with a support plan which sets out individual needs and wishes. We looked at a sample of support plans across the service. We found that staff have made good progress in providing more person centred plans which cover the physical, emotional, social and cultural needs and wishes of individuals. Plans are written in the first person which can assist staff in viewing people’s needs as individual to them. We found some good support plans with clear information on how the needs and wishes of individuals will be met. However this was not consistent across Ryelands DS0000007194.V367140.R01.S.doc Version 5.2 Page 11 the service. The manager is aware that further training would be needed for staff to ensure that everyone understands how to complete a person centred support plan with outcomes and goals. We found it was not always clear when reviews had been carried out as this information was combined with daily recording. Further work could be done on including more detail of reviews to include outcomes, what has worked well or otherwise and who was involved in the planning and reviews. Support plans should be reviewed monthly. Where changes to the needs or wishes of a person are found a new support plan should be produced. People who use the service felt their health care needs were met. Staff monitor the health of individuals and this was reflected in the records we saw. We found staff generally noted when individuals were experiencing health problems and took action by arranging appointments with their GP or other health care professionals. At the time of this visit one person was being supported to attend the local GP surgery for an appointment. The record of weight could be improved. Staff keep a record of the weight of individuals but were not always recording actions taken where a person was experiencing significant weight loss or gain. We found medication was well managed. Records of medication were up to date and accurate and medication was appropriately stored. Staff who administer medication have received accredited training on medication. Staff carry out a regular audit of the medication in the home to make sure that it remains well managed. We found one instance where medication was not give to one person for three mornings with no information on discussions with their GP about changing times or what side effects should be looked for. Staff should take care to make sure that this information is recorded. We observed staff asking individuals if they had any pain and providing pain killers when needed. This assists in ensuring that individuals are not living with pain. Consideration should be given to carrying out pain assessments for those people who may not be able to tell staff if they are feeling pain. We observed staff working with people who use the service in a sensitive manner offering support in a discreet way which protected privacy and dignity. We noted that certain individuals had Do Not Disturb notices for their doors. Consideration should be given to issuing these to everyone who uses the service. Ryelands DS0000007194.V367140.R01.S.doc Version 5.2 Page 12 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 this service experience good quality outcomes in these areas. This judgement has been made using available evidence including a visit to this service. People who use this service have opportunities to take part in a variety of activities. This is an area which could be improved particularly for those people who are living with dementia. Food is of a good quality and staff consult with people who use the service on any changes to menu. EVIDENCE: People who use the service told us there was “always” or “usually” activities arranged which they could take part in. Individuals also told us that they made their own choices about what to join in with. We saw staff offering people choices in their day to day activities. The service employs two activities coordinators who set up a variety of sessions which are available seven days a week. A Volunteer Support Group provides support to individuals and with group activities. The programme on display at the time of this visit included ball games, sensory, setting tables, helping with lunch, singing and dancing, memory lane, walking in the garden. Ryelands DS0000007194.V367140.R01.S.doc Version 5.2 Page 13 We saw that staff were collecting good information on the interests and work life, both present and previous, for people using the service. However this was not always reflected in the activities on offer. This is an area which could be improved. We found that staff were looking at more focus on activities of daily living in Brooklands unit. One person had expressed a wish to do a little light housework around the unit and one person was helping with setting tables. This type of activity should, when developed, provide a more person centred approach to meaningful day to day occupation. When reviewing activities consideration should be given to the gender of the group. There is a laundry room in Ryelands for people who wish to do their own washing. Staff told us that a number of people do their own washing and have set days that they do this task. We observed staff taking time to talk with people on a one to one basis and we saw good communication between staff and people who use the service. Individuals were watching the television, listening to music, walking round the garden, talking with staff and other people at the home, having visitors and going out in the local area during our visit. A variety of games and books and a box of musical instruments were seen to be available on Brooklands unit. However the books and games were set out in a bookcase and the box of instruments were not easily accessible. Consideration should be given to introducing more items which people could interact with in this unit both in the lounge/dining room and in the corridors. At the time of the last inspection we were informed that plans were in place to develop life story work and introduce head and hand massage. The manager informed us through her assessment that these plans were still in place. The activities programme on display at the time of this visit was from the previous month. The programme was produced in a written format in small print. Consideration should be given to displaying what is on offer in a more accessible way for people who use the service. We saw information about individuals’ religion and how their spiritual needs will be met. One case file noted the persons’ religion with an additional comment that they had no cultural requirements, however there was clear information that there were cultural requirements. Staff need to take care to acknowledge and address cultural needs and wishes. Many of the people we spoke to told us that the religious aspect of the service was an important part of their lives. The service has a dedicated Chaplain who is involved in many aspects of life in the home. The Chaplain visits the home four times a week and told us she works with the activities staff to support group discussions and activities. Ryelands DS0000007194.V367140.R01.S.doc Version 5.2 Page 14 During this visit a group of people watched songs of praise and joined together to sing hymns. Three services are held in both units each week with a weekly bible study group, a bible discussion group and a support group for people from both units. A list of services, discussion and study groups for the week are provided for each person in their rooms. Staff will support individuals to attend other places of worship for different and faiths. Lunch was seen to be a well organised and social occasion. Staff offered people choices throughout the meal and individuals were given time to eat at their own pace. The majority of people who gave an opinion on the food told us that they “usually” enjoyed the meals provided. One person was less than happy with the variety of food available and was concerned about the amount of wasted food. The manager informed us that she was working with staff to make sure that those people who request a small amount are provided with this. One person informed us through a survey that hot food was often served up on cold plates. The manager informed us that this issue had already been addressed. We observed food being served appropriately. Records showed that people who use the service are consulted on the menu on a regular basis. More consideration could be given to how choices are offered to people who have problems with short term memory and may have sensory impairment. Consideration should be given to providing pictorial menus and offering both choices at the time of the meal at the table. At the time of the last inspection it was noted that no information was available on the menu as to what, if anything, was available after the last meal of the day. A snack should be offered to everyone who uses the service in the evening to ensure that the gap between the last food of the day and breakfast is not too long. This should be included on the menu. Visitors are welcome at any time. Visitors we spoke to told us that staff made them feel “very welcome” and expressed confidence in the staff group to keep them informed of any changes or concerns. We saw that daily recording made by staff tended to focus on the physical support provided. Staff should include information on how the social, emotional and cultural needs of individuals are being met. Ryelands DS0000007194.V367140.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 People who use this service experience good quality outcomes in these areas/ This judgement has been made using available evidence including a visit to this service. People who use the service know how to make a complaint. A full record of complaints is kept with details of any investigation and outcomes. The service understands the procedures they must follow for safeguarding individuals. EVIDENCE: People who use the service told us that they knew who to talk to and how to make a complaint if they were concerned about anything. Staff have a good understanding of what they should do if anyone approaches them with a complaint. The organisation has in place a clear complaints procedure with set timescales for responding. The service keeps a record of any complaint along with details of actions taken and outcomes. We saw that complaints had been taken seriously and responded to appropriately. The service follows the local authority procedures for reporting any safeguarding issues. The organisation has its own safeguarding policy. Many of the staff have received training in safeguarding vulnerable adults. This ensures that they can recognise abusive behaviour and understand their role and responsibilities for reporting any concerns or suspicions of abuse. Ryelands DS0000007194.V367140.R01.S.doc Version 5.2 Page 16 At the time of this visit the manager was in the process of updating the staff training record which was not complete. Once this is completed any staff who have not received training on safeguarding people must be provided with this training. Ryelands DS0000007194.V367140.R01.S.doc Version 5.2 Page 17 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, 20, 24 & 26 People who use this service experience good quality outcomes in these areas. This judgement has been made using available evidence including a visit to this service. The service is well maintained and offers a comfortable, pleasant place to live. Further work could be done to make the environment more stimulating and user friendly for people living with dementia. Individual bedrooms are well equipped and people are encouraged to personalise their rooms. Plans are in place to replace carpeting. EVIDENCE: This is a purpose built service which provides good standards of accommodation. People who use the service told us they had all they need in their room. Each room has an en suite shower and toilet. A kitchen area with a fridge and sink is provided in each room so that snacks and drinks can be made. Everyone is offered a key to their room and doors are fitted with doorbells. It was clear in Ryelands DS0000007194.V367140.R01.S.doc Version 5.2 Page 18 discussions that many people who use the service take great pride in their rooms. We noted that pictures had been added to separate bathrooms to make these areas appear less clinical. We saw a number of notices on Brooklands unit which were out of date, small print and or related to activities for staff. Care should be taken to ensure that any notices are kept to staff areas and information for people who use the service is more accessible. As noted at the last inspection the environment in Brooklands could be improved in line with current good practice in dementia care. We found the carpet in the lounge area in Brooklands in very poor condition. This was highlighted at the last inspection. We also found carpets on Ryelands in need of cleaning or replacement. There was a strong odour in certain areas of this unit. One person who uses the service told us they felt their room could do with being cleaned more frequently. We would recommend the quality and frequency of cleaning is discussed at the next meeting with people who use the service. We were informed by the manager that quotes had been sought for the decoration of corridors throughout the service and that carpets would be replaced once this was completed. The lounge carpet in Brooklands must be replaced as soon as possible. Ryelands DS0000007194.V367140.R01.S.doc Version 5.2 Page 19 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 this service experience good quality outcomes in these areas. This judgement has been made using available evidence including a visit to this service. People who use the service have confidence in the staff who support them. Improvements have been made in ensuring the right checks are carried out on staff before they start work in the service. This assists in safeguarding people. Good opportunities are available for staff to increase their knowledge and skills through training. EVIDENCE: People who use the service and visitors made positive comments about the approach and quality of care provided by staff. People who use the service in Ryelands did raise concerns that at times there did not appear to be sufficient staff on duty. Staff gave mixed comments about this. Some said they felt they could do with more staff to meet individual needs with others telling us there were enough staff. We saw a quick response to call bells and didn’t see people waiting for support or assistance from staff. The organisation should continue to monitor response times to call bells particularly at peak times in the mornings. At night staff make two hourly checks on individuals, with more frequent checks should anyone be unwell. Ryelands DS0000007194.V367140.R01.S.doc Version 5.2 Page 20 One person who uses the service felt that at times communication could be difficult with staff who’s first language was not English. The manager is aware of this and informed us that they were liaising with local colleges to provide additional English course for staff. Staff told us they felt well supported in their work. Staff meetings take place once a month which ensures that staff are kept informed and up to date. Records showed individual staff receiving regular supervision and this was confirmed by staff we spoke to. At the time of this inspection the manager was in the process of updating the staff training record. It was therefore difficult to get an overall picture of the current training needs of the staff group as a whole. Individual staff told us they had taken part in training on manual handling, health and safety, food hygiene and safeguarding vulnerable people. One member of staff told us that they had completed dementia care training over several months at a local college. Another member of staff told us they had watched a video about dementia care. One member of staff told us they had received no training on dementia care. All staff should be provided with dementia care at a level appropriate to their role. This will ensure that everyone who works in the home has some understanding of the needs of individuals and how these may be met. It is recommended that the service subscribe to regular publications on dementia care to ensure that staff are kept up to date with current good practice. Twenty five staff have completed NVQ level 2 in care. One member of staff has completed level 3 and two staff are in the process of this training. One person is enrolled on an NVQ course for providing therapeutic activities. Staff confirmed that they went through an induction programme when they first started to work in the service. This assists in familiarising new staff with the way the service operates. The organisation has produced role specific induction packs for staff. We looked at a sample of staff files. These were found to be in good order with evidence of pre employment checks having been carried out. This assists in ensuring the safety of people who use the service. Ryelands DS0000007194.V367140.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33 & 38 People who use this service experience good quality outcomes in these areas. This judgement has been made using available evidence including a visit to this service. Although the service has yet to get a permanent manager in post improvements have been made in ensuring procedures are followed consistently across the service. The organisation has good systems in place for consulting with people who use the service as part of their quality assurance and monitoring. Staff carry out regular checks to ensure the health and safety of people who use the service, staff and visitors. EVIDENCE: Ryelands DS0000007194.V367140.R01.S.doc Version 5.2 Page 22 The manager has been in post since April of this year. This is a temporary post until a permanent manager can be found. The present manager works as a peripatetic manager for the organisation. She has the experience and knowledge appropriate for this post. People who use the service are consulted on the way the service is run through monthly meetings. Records of the last of these meetings showed a number of issues were discussed including, a new planned staffing structure, cleaning, meals, maintenance issues and the introduction of a memorial book. The organisation has its own quality assurance and monitoring systems which include surveys for people who use the service which feed into an annual review and development plan. In addition a six monthly audit is carried out which involves people who use the service and junior staff. A newsletter is produced which assists in keeping people who use the service up to date with what is going on. The newsletter was seen to be available in the entrance hall and included information on the service, the new acting manager and birthdays being celebrated. People who use the service are encouraged to manage their own finances but facilities are available for the safekeeping of small amounts of cash in the main office. The records of this money were found to be well maintained at the last inspection. These were not examined at this inspection. Staff make regular checks on the building to ensure the safety of people who use the service. Record show hot water temperatures and the fire alarm system are checked each week. A monthly check is made on the building to ensure that any repairs are carried out promptly. Ryelands DS0000007194.V367140.R01.S.doc Version 5.2 Page 23 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 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 3 X X X 4 X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X X X X 3 Ryelands DS0000007194.V367140.R01.S.doc Version 5.2 Page 24 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 OP18 Regulation 13(6) Requirement To ensure that people who use the service are protected from abuse the current audit of staff training must be completed. Timescale for action 30/10/08 2. OP26 23(2)(d) 3. OP30 18( c)(i) Any staff found to not have taken part in training on safeguarding adults must be provided with this training. To make sure that people who 30/10/08 use the service are provided with a comfortable and clean environment the carpet to the lounge in Brooklands must be replaced. To ensure that staff understand 30/11/08 the needs of and can provide the appropriate support to people living with dementia all staff must be provided with training on dementia care at a level appropriate to their role. Ryelands DS0000007194.V367140.R01.S.doc Version 5.2 Page 25 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 OP7 Good Practice Recommendations In order to ensure that people who use the service receive a person centred service further training should be provided to staff on providing and reviewing support plans. Support plans should be reviewed monthly or more frequently should there be any changes. To ensure the health of people who use the service staff should record the actions taken should individuals lose or gain a significant amount of weight over a short time. In order to ensure that people who use the service do not suffer unnecessary pain consideration should be given to introducing pain assessments for those people who may be unable to tell staff when they are feeling pain. To ensure that the needs and wishes of people who use the service are met staff should take into account the cultural needs and wishes of the individual. Daily recording should include information on how the social, emotional and cultural needs of individuals are being met. A review of meal times should be carried out to include:_ Providing menus in different formats The provision of a snack in the evening The presentation of food The use of bibs. A review of the environment in Brooklands should be carried out with a view to making this unit more user friendly for people living with dementia. Consideration should also be given to introducing more interactive items such as rummage boxes in communal areas. In order to ensure that sufficient staff are available to meet the needs of people who use the service the time taken to respond to call bells should be monitored on a regular basis with records kept. 2. 3. OP8 OP8 4. OP12 5. OP15 6. OP19 OP12 7. OP27 Ryelands DS0000007194.V367140.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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 Ryelands DS0000007194.V367140.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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