Care Home: Rylands

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What the care home does well The home provides a comfortable environment in which to live, the ongoing building works to provide an extension to the premises together with the refurbishment and redecoration of the existing building will further enhance the standard of the accommodation for the people living, working and visiting the home. People commented that `Staff look after us well`,`Home is always fresh and clean`. `Love it here, staff are lovely, food always enjoyable` `Comfortable stress free life with all care provided`. The cleanliness of the home is maintained to a high standard. The manager demonstrated a good in-depth knowledge of the resident group and the conditions and dilemmas associated with the ageing process. What has improved since the last inspection? No requirements were made following this inspection or the inspection conducted in November 2006. The service continues to provide good outcomes for people living at the home. What the care home could do better: CARE HOMES FOR OLDER PEOPLE Rylands 74 Forton Road Newport Shropshire TF10 8BT Lead Inspector Joy Hoelzel Unannounced Inspection 09:00 30 October 2007 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 Rylands DS0000064650.V351780.R03.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. Rylands DS0000064650.V351780.R03.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Rylands Address 74 Forton Road Newport Shropshire TF10 8BT 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) 01952 814871 01952 825536 Rylands Care Limited Tracie Deborah Peate Care Home 34 Category(ies) of Old age, not falling within any other category registration, with number (34) of places Rylands DS0000064650.V351780.R03.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home must provide the following minimum staffing levels for 34 service users: 8am-2pm - 2 RNs and 6 Care Assistants: 2pm-8pm - 2 RNs and 6 Care Assistants: 8pm-8am - 1 RN and 3 Care Assistants. These are minimum levels required throughout the 24hr day, including weekends, for service users who have low to medium dependency nursing needs. Additional staff must be on duty when high dependency service users are accommodated. These minimum levels are for direct nursing and personal care only. They do not include ancillary staff. They are exclusive of the manager`s time. 22nd November 2006 Date of last inspection Brief Description of the Service: The Rylands is a care home offering both personal and nursing care to 34 people. The home is situated on the outskirts of Newport. Rylands is privately owned by Rylands Care Limited, the Responsible Individual being Dr Mark Cowling and Ms Tracie Peate, the registered manager. The Home is a large, converted country house with accommodation provided on three floors. Communal lounges and dining rooms are situated on the ground floor with bedrooms on all three floors. The two upper floors are accessed via a shaft lift or stairs. The home is currently undergoing an extensive building programme to increase the number of beds available, increase and improve the communal areas with a planned completion date of July 2008. Weekly fees for the service range from £425.00 - £620.00. Information of the home and the provision of the service are available in the statement of purpose and service user guide, both documents have recently been revised and are readily available. Commission for Social Care Inspection Reports for this service are available from the provider or can be obtained from www.csci.org.uk Rylands DS0000064650.V351780.R03.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over six hours on Tuesday 30th October 2007. It was conducted by one Commission for Social Care Inspection (CSCI) regulation inspector. Twenty two of the thirty eight National Minimum Standards for Care Homes for Older People were inspected as they are viewed as key standards for services. Twenty nine people are currently living at the home and during the inspection were observed to be accessing all areas of the home. The registered manager was on the premises supported by the deputy manager, two registered nurses, four care staff, and ancillary personnel. The director of the service was also on the premises. The care provided for four people were examined in detail, relevant documents were inspected, discussions were held with people living at the home, visitors, members of staff and the management team. Observation was made of the various daily activities and a tour of the premises was conducted. An Annual Quality Assurance Assessment (AQAA) had been completed by the manager and submitted to CSCI prior to this inspection, offering a full overview of the home. On site surveys were distributed during the inspection and completed by people living and working at the home. The comments received are included in this report. What the service does well: The home provides a comfortable environment in which to live, the ongoing building works to provide an extension to the premises together with the refurbishment and redecoration of the existing building will further enhance the standard of the accommodation for the people living, working and visiting the home. People commented that ‘Staff look after us well’, Rylands DS0000064650.V351780.R03.S.doc Version 5.2 Page 6 ‘Home is always fresh and clean’. ‘Love it here, staff are lovely, food always enjoyable’ ‘Comfortable stress free life with all care provided’. The cleanliness of the home is maintained to a high standard. The manager demonstrated a good in-depth knowledge of the resident group and the conditions and dilemmas associated with the ageing process. What has improved since the last inspection? 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. Rylands DS0000064650.V351780.R03.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 Rylands DS0000064650.V351780.R03.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): OP 3,6 Quality in this outcome area is good. The home provides a Statement of Purpose that is specific to the individual home, and the resident group they care for. Admissions are not made to the home until a full needs assessment has been undertaken (except in special circumstances) and only take place if the service is confident staff have the skills, ability and qualifications to meet the assessed needs of the prospective resident. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information about the service is detailed in an information pack and includes the statement of purpose and service user guide. The documents are available at the home upon request. Rylands DS0000064650.V351780.R03.S.doc Version 5.2 Page 9 The deputy matron confirmed that whenever possible people are visited in their place of residence and pre admission assessments and information are obtained prior to offering a place. Two people spoken with stated that it was close vicinity of the home to their relatives that made the home very suitable for their specific needs One person discussed their decision to move permanently into the home and stated ‘As I live nearby I knew where the home was and I had made enquiries from people who had been here. My wife was resident so I had no second thoughts about moving in myself and have no regrets that I did so. A very happy place to live with lovely staff from top to bottom’. Another person stated – ‘‘ My relative arranged the placement for me, I lived away from this area but she lives only around the corner so it is very convenient’. The home does not provide an intermediate care service. Rylands DS0000064650.V351780.R03.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): OP 7,8,9,10. Quality in this outcome area is good. Each individual has a care plan, which is developed and reviewed with the involvement of the person and/or their representative. Personal healthcare needs including specialist health, nursing and dietary requirements are generally recorded in each persons plan; they give an overview of their health needs and act as an indicator of change in health requirements. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All people living at the home have a plan of care, which is developed with the involvement of the individual whenever possible and/or their representative. All care plans used are based on the problem, aims, nursing intervention Rylands DS0000064650.V351780.R03.S.doc Version 5.2 Page 11 and evaluation and cover all areas of healthcare including mobility, pressure area care, maintaining a safe environment, continence, nutrition and specialist interventions. The malnutrition universal screening tool is used to identify expediently any concerns relating to weight losses and gains. One person had a slight weight loss over a period of two months; the care plan was amended to give staff the additional details of how to monitor that an adequate diet and fluids were offered and taken on a daily basis. Generally the information in the care plan is in sufficient detail to give staff the information to ensure that all care needs of the individual are fully met. Minor amendments and additions of information was discussed and agreed with the management team, an assurance was offered that the plan would be expediently reviewed. Observations of staff working practice evidenced that interventions for assisting with personal care were undertaken in private, in an appropriate manner and points to the care needs of people are being satisfactorily met. The people living and working at the home appear to have developed good relationships with each other there was lots of chatter and discussions occurring. Staff were observed to be offering many choices and carrying out interventions in a calm, efficient and competent manner. All people looked very well groomed, care for and nourished. Inspection of medicine storage and administration records, demonstrated the home’s practices meet the guidelines of the Royal Pharmaceutical Society. Rylands DS0000064650.V351780.R03.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): OP 12,13,14,15 Quality in this outcome area is good. People who live at the home are involved in meaningful daytime activities of their own choice and according to their individual interests and capabilities. The meals are balanced and nutritional and cater for the dietary needs of the individuals using the service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: In house and community based activities are organised and can be either a group activity or on a one to one basis. During the morning of the inspection people were observed to be in a variety of activity including some watching the television, whilst others were reading the newspapers, dozing or just sitting observing the happenings of the day. Rylands DS0000064650.V351780.R03.S.doc Version 5.2 Page 13 A religious service had been arranged during the latter part of the morning, with many people participating and afterwards enjoying a pre dinner glass of sherry. One resident stated – ‘Overall very good, not much to do though, I go to bed and get up when I want to, my relative visits every day. Food and staff are alright’ Two residents completed the in house survey and stated that sufficient activities were arranged; one person added an additional comment of – ‘ Usually very enjoyable’. Many visitors were at the home and appeared to be at ease, staff were very welcoming, two people commented – ‘We live very close by so are able to visit very often., we are wholly satisfied, staff are extremely caring and not only to the residents. Have no problems what so ever’. During the tour of the premises many bedrooms contained personal possessions, one person stated that they were satisfied with their own room and said that it was ‘a home from home’. People have the choice of where to take their meals but are encouraged to go to the dining areas whenever possible. The dining rooms are well furnished and prepared in advance of the meals. Staff were observed to be encouraging and assisting people with the midday meal in a discreet way showing patience and understanding of the individuals needs. People living at the home stated ‘Love it here, staff are lovely, food always enjoyable’ ‘I like the food’ Rylands DS0000064650.V351780.R03.S.doc Version 5.2 Page 14 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): OP 16,18 Quality in this outcome area is good. Residents and others involved with the service say that they are happy with the service provision, feel safe and well supported by an organisation that has their protection and safety as a priority. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a comprehensive complaints policy, which is included in the statement of purpose and service user guide. A copy is displayed in the entrance of the building. People spoken with said they didn’t have any complaints but would feel very comfortable to speak with the manager or staff at any time. The matron confirmed that no complaints or safeguarding adult referrals have been made since the last inspection in November 2006. Protection of vulnerable adults training for all levels of staff continues through out the year. Rylands DS0000064650.V351780.R03.S.doc Version 5.2 Page 15 The home offers a facility for residents to deposit personal monies for safekeeping; records relating to this have been maintained and fully receipted. Rylands DS0000064650.V351780.R03.S.doc Version 5.2 Page 16 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): OP 19,26 Quality in this outcome area is good. The service provides a physical environment that is appropriate to the specific needs of the people who live there. It is comfortable, and the planned programme to improve the decoration, fixtures and fittings will further enhance the standard of the accommodation. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is currently undergoing major building works to extend the premises and to refurbish the existing building. The management team discussed the anticipated plan for a new conservatory and redecoration of the lounge before Christmas, with a full completion date of July 2008. Rylands DS0000064650.V351780.R03.S.doc Version 5.2 Page 17 The lounge and communal areas are warm, homely and comfortable with a variety of armchairs to suit the needs of the individuals. During the tour of the premises some beds were fitted with bedrails to ensure a person’s safety whilst in bed. It was recommended that these be checked on a regular basis to ensure that they are correctly fitted and in good working order. Staff demonstrated a good knowledge of infection control procedures. Hand wash facilities have been provided in all communal areas and at the point of the delivery of care. All areas of the home were spotlessly clean; the staff responsible for the household cleaning must be commended on maintaining such high standards. Rylands DS0000064650.V351780.R03.S.doc Version 5.2 Page 18 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): OP 27,28,29,30 Quality in this outcome area is good. There appear to be enough staff available to meet the needs of the people using the service, with the staffing structure based around delivering outcomes for the people using the service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: General observations and discussion with staff confirmed that staffing numbers and skill mix enable a service provision, which meets the care needs of the people living at the home. Staff were observed to carry out their duties in an enthusiastic and professional manner. All residents looked well groomed and it was obvious that the staff assisted people with maintaining high standards of personal care. Staff training continues to be available for all staff with 50 of the care staff having achieved accreditation in National Vocational Qualification level 2 in Rylands DS0000064650.V351780.R03.S.doc Version 5.2 Page 19 care with the registered provider confirming that another eight care staff are currently working towards this award. Records examined showed they contained all the necessary information, which demonstrates potential staff are well screened before they are deemed suitable to start work at the home. Annual appraisals of each staff member identify the training and development needs, staff commented that training is ongoing in the core and specialist topic areas. Rylands DS0000064650.V351780.R03.S.doc Version 5.2 Page 20 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): OP 31,33,35,38 Quality in this outcome area is excellent. The registered manager has the required qualification and experience, is highly competent to run the home and meets its stated aims and objectives. There is strong evidence that the ethos of the home is open and transparent. The views of both people who use the service and staff are listened to, and valued. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Rylands DS0000064650.V351780.R03.S.doc Version 5.2 Page 21 Ms Tracie Peate is a first level nurse and has been the registered manager at the home for several years and is supported by a deputy manager, Ms Debbie Willis. Both Ms Peate and Ms Willis demonstrated a sound knowledge and understanding of the client group and the difficulties and dilemmas associated with ageing. People offered positive comments of the style of leadership and stated that the management team was ‘ very supportive, and approachable, and would have no hesitation but to ask to see them if there were any concerns’. One staff member stated – ‘Good support from the managers like a big family. Monthly meetings with an opportunity to discuss any concerns. There is an active training programme’. The manager stated that there are numerous formal and informal opportunities for staff and service users to discuss any concerns or difficulties together with suggestions for improving the service. Quality assurance and monitoring of the home continues with annual surveys and satisfaction questionnaires being audited by the manager with suggestions for improvements being acted upon. Following suggestions from the recent audit, a selection fresh fruit is available and offered to all people at teatime as well as upon request. The home offers a facility for residents to deposit personal monies for safekeeping; records relating to this are maintained, fully receipted and available for inspection. Weekly, monthly and annual testing of the equipment and premises are conducted with records kept. Some difficulties have been noted with maintaining a safe water temperature at around 43 degrees Celsius; this was discussed with the management team. It was confirmed that all hot water outlets are to be fitted with fail-safe valves during the refurbishment. It was advised that outlets accessible to service users should be risk assessed with action taken to reduce the risk of a potential scalding injury if necessary. An outside contractor carried out the fire risk assessment for the premises last year, this continues to be reviewed and revised in line with the building works. Rylands DS0000064650.V351780.R03.S.doc Version 5.2 Page 22 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 X X 3 X X N/a HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 4 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 4 X 3 X X 3 Rylands DS0000064650.V351780.R03.S.doc Version 5.2 Page 23 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. Standard Regulation Requirement Timescale for action 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 OP38 Good Practice Recommendations Risk assessments should be carried out on all hot water outlets that are accessible to service users that are not currently fitted with a fail-safe valve. Details should be available for how the risk of scalding can be reduced. Rylands DS0000064650.V351780.R03.S.doc Version 5.2 Page 24 Commission for Social Care Inspection 1st Floor Chapter House South Abbey Lawn Abbey Foregate Shrewsbury SY2 5DE 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 Rylands DS0000064650.V351780.R03.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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