Care Home: The Rambla Nursing Home

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What the care home does well What has improved since the last inspection? This is the first key inspection since the new owners took over. However, the general manager and registered manager are actively looking at ways that they can improve the service, taking into account people`s views. CARE HOMES FOR OLDER PEOPLE The Rambla Nursing Home 374 Scalby Road Scarborough North Yorkshire YO12 6ED Lead Inspector Anne Prankitt Key Unannounced Inspection 28th August 2008 10:00 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 The Rambla Nursing Home DS0000071488.V371131.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. The Rambla Nursing Home DS0000071488.V371131.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Rambla Nursing Home Address 374 Scalby Road Scarborough North Yorkshire YO12 6ED 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) 01723 500136 01723 500522 heather.rambla@googlemail.com Neil Deelun Somauroo Mr Abdool R D Somauroo Heather McCausland Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30) of places The Rambla Nursing Home DS0000071488.V371131.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 with Nursing Code N To service users of the following gender: Either Whose primary care needs on admission to the Home are within the following category: Old Age, not falling within any other category, Code OP - maximum number of places 30 The maximum number of service users who can be accommodated is: 30 Not applicable 2. Date of last inspection Brief Description of the Service: The Rambla Nursing Home now has new owners. Therefore it is classed as a new service. It provides nursing care and accommodation for up to 30 people. The home is situated on the outskirts of Scarborough close to the village of Scalby. There is a regular bus service that provides transport to the town of Scarborough. The home is close to local amenities including a library, shops and churches. There are gardens at the rear of the building. Private parking is available at the front. The accommodation is provided over two floors with access to the first floor via a passenger lift. All bedrooms provide single occupancy accommodation, and eighteen have en suite facilities. People interested in living at the home are given a brochure before they are admitted. This tells them what the home provides. There is also a service users’ guide and a Statement of Purpose which gives more detail should they wish to see it. The registered manager said that the inspection report will be made available to anyone who wants to see it once it is published. On 28 August 2008 we were told that the weekly fees ranged from £600 to £620. This fee does not take into account the free nursing care contribution, which is deducted and backdated once the person has been assessed. Costs for hairdressing, toiletries, chiropody, dry cleaning, papers and magazines are not included in the fee. The Rambla Nursing Home DS0000071488.V371131.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 the people who use this service experience good quality outcomes. The key inspection included a review of the following information to provide evidence for this report: • • Information that has been received about the home since the last inspection. A self assessment called an Annual Quality Assurance Assessment (AQAA). This assessment told us how the registered manager thinks outcomes are being met for people using the service. It also gave us some numerical information about the service. Comment cards from seven people living at the home. A visit to the home by one inspector. • • During the visit to the home, several people who live there, a relative, some staff, the registered manager and the general manager were spoken with. Four people’s care plans were looked at, as well as two staff recruitment files, some policies and procedures, and some records about health and safety in the home. Care practices were observed, where appropriate. Some time was also spent watching the general activity to get an idea about what it is like to live at The Rambla. Feedback was given to the registered manager and the general manager at the close. What the service does well: Although people’s needs are not always recorded in a personal way, people know that staff understand them, and try to provide care the way they want. One person said ‘I have been made to feel very welcome. Nothing is too much trouble for the staff’. Another said ‘I had a lovely shower this morning – just how I like it’. People are treated with respect. Staff are polite and listen to what they say. They will take the right action if they believe someone is unhappy, or has not been treated properly. One person said ‘I feel really, really safe’. People can have their visitors whenever they want. Staff are friendly to them, and welcome them into the home. They get choice in their daily lives, which means they are seen as individuals. One person said ‘Staff are lovely – I can The Rambla Nursing Home DS0000071488.V371131.R01.S.doc Version 5.2 Page 6 go out when I want – I tell them when I want to go to bed and when I want to get up. It’s like a hotel. And my husband comes and goes as he pleases’. The home is clean and pleasant. Everyone has their own bedroom. This means that they can personalise it to their own taste, and can enjoy privacy when they want it. The registered manager and general manager listen to people and staff. They are thinking of different ways that they can collect people’s views, so they can be certain the home is running the way people want it to. What has improved since the last inspection? What they could do better: People’s care plans could be more individual, and they or their family could be more involved when they are written and reviewed. The management are already aware of this, and are doing something about it to make things better. However, priority must be given to making sure that risk to people is always assessed with the specific needs of the individual in mind. This will help to make them accurate and in the person’s best interests and safety. The way that people’s medication is checked could be more thorough so that shortfalls and problems can be picked up on quickly, and put right. The way staff are recruited could be improved so that, in all cases, staff have the proper checks in place before they start working with people. This will make sure that all staff at the home are suitable people to provide care. People could be given a list of activities that are due to take place at the home, so they can organise their time, and attend the sessions that interest them. They could also be given more information in advance about what is on the menu, so they can look forward to their favourite meals. As part of the questions that the home asks people about how the service runs, they could be asked specifically about the menu and also the availability of staff, to check if they think any adjustments need to be made in each of these areas. This will keep people included when possible changes are being considered. Staff could be given a means of recording any complaints made to them when the registered manager is mot available. This will help to make sure that important information about people’s concerns is passed on fully. Please contact the provider for advice of actions taken in response to this The Rambla Nursing Home DS0000071488.V371131.R01.S.doc Version 5.2 Page 7 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. The Rambla Nursing Home DS0000071488.V371131.R01.S.doc Version 5.2 Page 8 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 The Rambla Nursing Home DS0000071488.V371131.R01.S.doc Version 5.2 Page 9 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): 3 and 6 People who use the service experience good outcomes in this area. Staff aim to keep people involved in their assessment before they move in, and enough information is collected from others to make a judgement as to whether the home will be suitable for them. We have made this judgement using a range of evidence including a visit to the service. EVIDENCE: Everyone living at the home needs nursing care. People who are thinking of moving there are always assessed by the home’s staff first, to make sure that their needs can be met. The assessment paperwork that staff now use asks lots of questions about people’s physical, psychological and social needs. This helps to make sure that important parts of their care are not overlooked when the assessment is done. This helps everyone to make an informed decision about whether The Rambla will be suitable for the person concerned. One assessment recently completed had been looked over and signed by a relative. Both they and the person concerned had been involved in the assessment. This means they were able to give their views about what mattered to them. The Rambla Nursing Home DS0000071488.V371131.R01.S.doc Version 5.2 Page 10 Before moving in, people and their relatives are invited to look round to see what the home is like, and to meet staff. This isn’t always possible, so staff make sure that everyone gets a brochure so they can at least have some insight into what their future home will be like. Staff also ask for information from other professionals who have previously played a part in the person’s care. They check that all the information they have matches up, and that there are no further questions to be asked about what support the person will need. Care staff said that they get good information about the person before they are admitted. This helps to make sure that the care they get is right from the start. People are given some written information called a contract when they are admitted, which explains who is paying for what aspect of their care. Care must be taken to make sure that the information given to them is updated as changes are made. For instance, when a nursing assessment has been completed, details of this should be included in the breakdown of fees. Some people had old contracts, which did not include such a breakdown. The general manager knew that this was the case, and said that the information is being updated to reflect the new ownership. Everyone who returned their survey said that they got enough information about the home before they moved in, and the majority knew that they had a contract. One had made their choice because the home had a ‘good local reputation’. Another recently admitted person said ‘I have been made to feel very welcome. Nothing is too much trouble for the staff’. Another said their relative would soon be visiting soon for the first time. They said about their relative would ‘be so pleased’ with the home. The home does not provide intermediate care. So standard six is not applicable. But people can stay for short respite periods, often to give the person and their family a break. The Rambla Nursing Home DS0000071488.V371131.R01.S.doc Version 5.2 Page 11 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 and 10 People who use the service experience good outcomes in this area. The quality of care that people get is good, although this is not always reflected in their records. We have made this judgement using a range of evidence including a visit to the service. EVIDENCE: It has already been identified by the general manager that the care plans need to be improved to make them more personal. She has told us in a meeting how she plans to achieve this. This includes giving staff more training. It was unfortunate however that the detailed information provided in the pre admission assessment of a recently admitted person had not been used as a training opportunity to devise a new care plan for them using the new paperwork. People have access to their care plans at all times, because they are kept in their bedrooms. The care plans are duplicated sheets, with the name of the person concerned added. These encourage staff to look at all basic areas of people’s care, but give them less opportunity to describe this care in an individual way. This meant that sometimes the plans were not appropriate. For instance, one person admitted with a pressure sore had a pre printed care The Rambla Nursing Home DS0000071488.V371131.R01.S.doc Version 5.2 Page 12 plan, which planned for the prevention, rather than the ongoing treatment of what was already a problem. However, some of the entries made about peoples social activities were often written in a very individual way. So even though the care plan was duplicated, the regular entries gave a good picture about what had been provided to make their day more interesting. Whilst most basic risk assessments are in place, for instance about moving and handling people, or their risk from pressure sores, priority must now be given to the care plans where risk assessments have not been completed, or where they need further attention. For instance: • Where people display behaviour, or make sudden decisions which could affect their welfare, or which could mean staff have to make quick decisions to keep themselves and the person safe. The registered manager is going to seek some advice from suitable professionals, so they can review care where necessary, and support staff in planning and recording this, so that it is always given in a consistent way. Where a person’s risk assessment has been wrongly assessed, because staff have assumed that they have been given a medical diagnosis which they have not. Such assumptions increase the risk of people being ‘labelled’, and make the assessment less reliable. Where people have been assessed as being at risk from falls. The staff must make sure that they follow these assessments up with a care plan to show how risks of future falls can be kept to a minimum. Where a person had been supplied with bed safety rails before an assessment confirming the need for these has been completed. This action increases the chance of equipment being used inappropriately, and means there is not a consistent approach to their use. • • • People and their families are not normally asked to help when staff write and review their care plan. This should be encouraged as by doing so, staff may get valuable pointers about how and when people like to get their care, what is working, what is not, and where they would like adjustments made. However, people agreed that staff listen and act on what they say, and that they get medical support when they need it. The majority said that they always get the care and support that they need. One said ‘I had a lovely shower this morning – just how I like it’. People also said that staff treat them with respect, and that they understand that their privacy is important to them. This shows that, although people’s needs are not always written down, they feel confident that staff know what they are, and that they work hard to meet them. A visitor said they were highly satisfied, and very happy with the care. Staff look after people’s medication on their behalf. They keep it locked away safely. When medication arrives from the chemist, they check that it is correct. Staff keep a record to show what medication they have given, and when. The Rambla Nursing Home DS0000071488.V371131.R01.S.doc Version 5.2 Page 13 It has been the practice of the home that night staff complete the morning medication round. This means that people have to be woken up to be given medication by staff who have themselves been awake all night. This increases the risk from error because staff are tired, and it does not allow people to lie in undisturbed should they wish to. The general manager intends to stop this practice straight away, except where people choose to have their medicines early, or where their doctor has said that it is better for them to receive it before they rise. One person’s medication needed to be reviewed. Although it was to be taken only when needed, it had not been given for some time. The registered manager said they would deal with this straight away. Another person had run out of some medication because the staff were waiting to hear from the doctor about whether he needed to make any adjustments following a recent hospital admission. This was followed up on the day, so that the person got the medication prescribed to them without delay. One person’s eye drops should have been discarded, and a new bottle started, because it was out of date. However, these were still being given by staff. They were discarded immediately. The registered manager must consider these shortfalls when she checks the way staff look after people’s medication. This may help to reduce the risk of people getting medication that they no longer need, having to do without medication which has run out, or of receiving medication which may no longer work to it’s full potential. The Rambla Nursing Home DS0000071488.V371131.R01.S.doc Version 5.2 Page 14 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 and 15 People who use the service experience good outcomes in this area. People’s social needs are considered, but they could be offered more choice and variety at mealtimes. We have made this judgement using a range of evidence including a visit to the service. EVIDENCE: Of those surveyed, two people said there are always activities for them to join. Four said there usually is. One said that there sometimes is. There are two activities organisers who, as well as providing group activities, spend time with people individually. Some people’s records showed how they had enjoyed the activities in which they had participated, or watched. Where they did not, the staff could explain that it was the person’s choice not to be involved. One such person confirmed that they liked their own space, so chose not to join in. It would be good practice to give people a list of the forthcoming events. This would help them to plan ahead, and to arrange their time around events that they want to attend. Recent activities included a barbeque. On the day of the site visit, people were enjoying a group exercise activity, whilst a carer explained that she had spent time with a person looking at their photographs. Clergy visit to see people individually, and also to provide a communion service. This helps some people to maintain contact with the church so that their spiritual needs can be met. The Rambla Nursing Home DS0000071488.V371131.R01.S.doc Version 5.2 Page 15 Everyone said that they had choice over when they went to bed, when they got up, and how they spent their day. They appreciated this. Staff said that they try to keep flexible so that one day does not have to be the same as the next. Visitors are welcome at any time. One person said ‘Staff are lovely – I can go out when I want – I tell them when I want to go to bed and when I want to get up. It’s like a hotel. And my husband comes and goes as he pleases’. The cook said that food is always available even when she is not. This means that if people are hungry in the night, care staff can provide them with a snack. The cook has individual cards which tell her what people like to have for breakfast. She said that their likes, dislikes, and any dietary needs would also be recorded on the cards. She has no restrictions placed on her budget. This allows her to order sufficient food, much of which is delivered fresh from local suppliers. She fortifies meals where people have problems with their nutrition. This will help to keep their weight stable, and improve their nutritional wellbeing. Although staff ask in advance what people would like for tea, the lunchtime meal is not advertised, neither is there a set choice. So people do not know what’s for lunch in advance, unless they ask. They have different views about this. For instance, one person goes to the kitchen and tells the cook what they want for their meal. This means that they get what they want wherever possible. Another, who does not visit the kitchen, said that they sometimes just have vegetables because they like neither the meat on the set menu or the short notice alternative, which they say is ‘often beef burger’. Although there is a four week menu in place, this was not followed on the day of the site visit. It would be good practice to provide a written choice of menu, and to tell people in advance what the choice will be. This would allow them to look forward to a meal which they have chosen, and which they know they will enjoy. The mealtime was relaxed. Staff sat with people who needed help with their meal. This stops them from feeling rushed. Consideration is being given to a change round of the communal areas, so that a separate dining area is provided from the living area. This will mean that those who are able to sit with others at the table can enjoy a change of scenery when they eat. People’s views about the food varied, and included ‘The food is marvellous – I can have tea and coffee at any time – day and night – and chocolate cake’, ‘The tea choice isn’t very good – lots of sandwiches’, ‘the tea time meal can be monotonous’, ‘the teas are sometimes unsuitable’. One person said there could be a ‘better variety of main meals, for example spices, pasta, Chinese stir fry, instead of traditional fare’. The Rambla Nursing Home DS0000071488.V371131.R01.S.doc Version 5.2 Page 16 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 and 18 People who use the service experience good outcomes in this area. People are cared for by staff who will take their concerns seriously, and who will take the right action if they believe anyone is at risk from abuse. We have made this judgement using a range of evidence including a visit to the service. EVIDENCE: Everyone knew how to complain, although three out of seven people who returned their surveys were unsure who they should complain to. One person said ‘The occasion has not yet arisen’. Another said ‘I feel really, really safe’. Those spoken to on the day of the inspection said that the registered manager was very open, and that she listened to them. This will encourage them to speak out if they are unhappy about any aspect of their care in the future. The home has received four complaints in the last year. These involved issues about a staff member’s attitude, shortfalls in the standards within two people’s bedrooms, and concerns about staffing levels. There was a record kept of the investigation made and action taken by the home. Although it was confirmed that on each occasion the complainants were satisfied, this outcome was not always recorded. It would be good practice to note that this is the case for future reference should any similar concerns arise in the future. One complaint was made anonymously, direct to the Commission for Social Care Inspection. This was referred to the home to investigate, and a response was received once the investigation was completed. Staff knew what to do if they were told about any concerns. They said that they would report these to the registered manager straight away. This The Rambla Nursing Home DS0000071488.V371131.R01.S.doc Version 5.2 Page 17 included if they though a person had been mistreated, or abused. In such instances they knew that they could not keep secrets, even if the person asked them to. Staff acting in this way will make sure that everyone is protected from harm. Staff do not currently have access to a complaints form where they could record information given to them. This should be provided so that the content of any concern raised with them can be written down straight away. This will stop the chance of information being forgotten. Although staff spoken with were confident of the action they would take, not all have received training in safeguarding. They call this POVA (protection of vulnerable adults) training. The general manager is organising this, because she realises the importance of all staff members having the same information, so that they act correctly by telling the right people should they ever witness or be told about an incident of abuse. The Rambla Nursing Home DS0000071488.V371131.R01.S.doc Version 5.2 Page 18 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 and 26 People who use the service experience good outcomes in this area. People live in a clean and well maintained home. We have made this judgement using a range of evidence including a visit to the service. EVIDENCE: The home is situated on a busy road a short distance from the centre of Scarborough. It is clean, pleasant, comfortable and free from unpleasant smells. The new owners have put into place a plan of refurbishment so that the quality of the people’s accommodation does not slip. This has already involved the redecoration of some bedrooms. Some new seating has also been provided. As part of the handover to the new owners, the general manager informed us that the fire officer visited. A fire safety risk assessment has been completed, and is being checked by the company’s fire consultant to make sure that it considers people’s safety fully should a fire break out. She arranged for the fire officer to visit again, to check that the arrangements in the cellar meet The Rambla Nursing Home DS0000071488.V371131.R01.S.doc Version 5.2 Page 19 with current fire regulations. She also intended to check it was still appropriate for certain people to keep bedroom doors open during the night when they are not fitted with door closers. In the past they have been advised that this is acceptable. We have been informed that the visit has now taken place. Action is being taken to meet the recommendations made by him during his visit. Any decisions reached should be included in the home’s fire safety risk assessment. People can bring some of their own belongings with them when they are admitted. This helps to make their bedrooms more personal to them. All of the bedrooms provide single accommodation. This gives everyone the chance to be private, and to enjoy their own company when they choose to. People have call bells which can be taken with them wherever they go around the home. One person, who was resting on their bed, did not have their bell to hand, but there were staff about at the time to see to their needs. The registered manager said she would make sure that the bell was available to the person in future when they were alone. One person said that the water temperature to their sink was not constant. They said this meant that they could not get a good shave each morning. The general manager said that she would deal with this forthwith. There is only limited storage space at the home. So the bathroom areas are used for the storage of equipment such as laundry trolleys and hoists. The registered manager said that these were always removed from the bathroom before people took their bath. This will help to make the environment more pleasant and relaxing. The laundry is situated on a main corridor, but away from any food preparation areas. The laundry staff are provided with disposable gloves and aprons. Care staff deliver soiled linen to the laundry in special sealed bags which dissolve in the wash. This means that the laundry staff do not have to have direct contact with it, and so reduces the risk of cross infection. It was advised that staff working in this area should be given a copy of the safety information sheets which say what action should be taken in the event of a chemical spillage. This will help to make sure that they take the right action to protect themselves should a spillage occur. The registered manager agreed to do this straight away. All of the staff have had training so they know about how they can minimise the risk of infection. This helps to keep people free from unnecessary risk to their health. The Rambla Nursing Home DS0000071488.V371131.R01.S.doc Version 5.2 Page 20 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 and 30 People who use the service experience adequate outcomes in this area. Staff may not always be available to meet people’s needs in a timely way. Staff could be recruited better so that the risk to people from unsuitable workers is removed. We have made this judgement using a range of evidence including a visit to the service. EVIDENCE: There were mixed views from people about whether there were enough care staff – especially at night. One person said ‘I ring my bell and the staff are here in an instant’, and another said ‘Aye – there’s enough staff – but I see to myself’. But one person said they had to ring their bell during the night to let staff know that another person, unable to use their bell, needed assistance. They said this is because when staff are at one end of the building they cannot hear if someone shouts for help at the other. It is not acceptable that people should feel they have to ring their bell on behalf of others. Another person thought that there could be more staff at all times, and was used to having to wait for help. A staff member said they thought that the current night staff numbers were ‘only just adequate’. Another said they could do with more staff ‘especially at night’. The registered manager and general manager were already aware that there was some concern about the staffing levels available at night. They have taken The Rambla Nursing Home DS0000071488.V371131.R01.S.doc Version 5.2 Page 21 these concerns seriously. A night staff meeting had been arranged for that evening, and night staff had been given a questionnaire to give their views about how the night staff arrangements could be improved. It would be good practice to ask the views of the people who live at the home as well. This would give a clear picture about where they believed improvements could be made to the staffing arrangements, and would also let them know that the manager is doing something about any concerns or comments they may have. Two recruitment files were looked at. There were shortfalls in each file. The first person had started to provide care to people on the strength of one written reference, which was not from the previous employer, and a POVAFirst check. Although this checks that staff are not barred from providing care, it is not a full police check. The full check must be obtained before staff are permitted to work with people alone. However, this had not been put into practice formally. In the second staff file, the decision made to employ them based on the information available had not been recorded, therefore this suggested that their previous employment history had not been fully explored. However, the registered provider was able to give verbal confirmation that this had been done. New staff get a short induction on their first few days at the home. This is followed by an in depth induction. There were none to see, as staff tend to keep their induction records as they work through their file. However, one staff confirmed that they were in the process of completing theirs. They said they had good support when they started, so they were not left to complete tasks which they didn’t feel confident to do. And a trained member of staff explained that they worked alongside another nurse for some time before having to take charge of the shift. This gives staff the chance to get to know people, what care they need, and how the home operates. Staff are getting a range of training to help them in their work. There is a continuing programme in place so that staff achieve, or are trained towards NVQ (National Vocational Qualification) Level 2 or above in care. This will reassure people that staff are keeping up to date about the right way to give care. Distance learning courses in dementia care and palliative care are also being organised. However, enquiries should be made about training opportunities for staff on how to approach behaviour which may challenge. This would help them further in being consistent in their approach, and to write good care plans to reflect the action that they would take in such situations. The general manager has agreed to look into this. The registered manager is devising a better way of keeping track of who has had what training, so that training which is required by law, such as moving and handling and fire training, is kept up to date. The general manager expects that this training will be fully up to date by November 2008. The Rambla Nursing Home DS0000071488.V371131.R01.S.doc Version 5.2 Page 22 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): 31,33,35 and 38 People who use the service experience good outcomes in this area. The management are enthusiastic, and eager to make any changes to the way the home is run changes in accordance with people’s wishes. We have made this judgement using a range of evidence including a visit to the service. EVIDENCE: The manager has recently registered with the Commission for Social Care Inspection. She is now hoping to enrol on a course to work towards a management qualification. She has worked at the home for about twelve years. So she knows the people who live there, and the staff group who care for them, well. She spends most shifts concentrating on her management duties, but each week she spends some time with her staff providing direct care and supervision. Staff are satisfied with the management arrangements. One said they felt ‘very supported’ by the registered manager and also the general manager. Another said that the management are ‘approachable’. The Rambla Nursing Home DS0000071488.V371131.R01.S.doc Version 5.2 Page 23 The registered manager has regular support from the general manager. Together they are introducing the changes they want to make to how the home operates. They are starting to survey people, their family and professionals who play a part in their care, so that they can understand better where people want to see changes made at the home. This is good. By referring to people’s views as a matter of course, the service will be more successful in running it in their best interests. A recent survey carried out by them about privacy and dignity showed that people were generally satisfied with this area of their care. The general manager intends to display the results on the notice board so that people can see what was said collectively in response to the questions they were asked. It would be good practice now to ask their views about the menu, and staffing availability, as these are the two main areas in this inspection where people’s views differed. By doing so, the registered manager will be able to see collectively what, if any, changes need to be made. As part of the home’s self monitoring process, the general manager is setting up a number of audits to check that the different departments within the home are running as they should. This will help to make sure that standards do not slip. Relatives or solicitors manage people’s finances on their behalf when they are unable, or do not wish to do this themselves. The home can look after people’s personal allowances if they wish them to. People have access to their money at any time, because the person in charge has access to where it is stored. People are provided with lockable facilities in their room so that they can keep their valuables safe. From the information provided before the site visit, and a sample of certificates seen on the day, it was confirmed that the home is kept maintained. Where equipment was due for a service, this had been arranged. The maintenance man carried weekly checks within the home, and keeps records of the checks he has made. The weekly fire check had sometimes been missed when he had been on leave. The general manager agreed to make sure that this was carried out each week from now on, even in his absence, to check that there are no faults which may need attention. We were told that staff check the safety rails fitted to people’s beds on a daily basis, but do not record when this is done. Keeping a record would reduce the risk of one staff member assuming that another has carried out the check. One set of rails were checked. They were loose, and were not secured properly to the bed. The registered manager was instructed that all safety rails must be checked before the beds were next occupied, and from that point, a more formal system of checking must be introduced, so people can be assured that staff, with sufficient knowledge about how they should be fitted, check regularly to make sure that people will be safe from harm whilst they are in bed. The Rambla Nursing Home DS0000071488.V371131.R01.S.doc Version 5.2 Page 24 The kitchen is undergoing a major refurbishment. This will help to meet the requirements made by the Environmental Health Officer when they last visited. The general manager intends to invite the officer back when the work is completed, to check that everything that they required is in place. Paperwork has also been introduced as requested by the officer, to check, for instance, that food is being stored and served at the right temperature. The records seen were disorganised, as staff had signed in the wrong places. This makes it more difficult and time consuming for the manager to check that the kitchen is operating as required when she completes her audit. There is no kitchen assistant working with the cook. This means she is very busy, not only preparing and cooking the meals, but also completing cleaning tasks. The kitchen did look a little disorganised. This was partly due to the refurbishment, which is not yet complete. The registered manager was advised that it would be good practice to provide some extra help to get the area deep cleaned. By doing so it would then be easier for the cook to maintain the day to day cleaning tasks. The general manager agreed to organise this. In addition, if cleaning records were to be devised, the manager would then also be able to use these as part of her kitchen audit. The Rambla Nursing Home DS0000071488.V371131.R01.S.doc Version 5.2 Page 25 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 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 1 The Rambla Nursing Home DS0000071488.V371131.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? Not Applicable 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 OP7 Regulation 13 Requirement Priority must be given to the review of people’s risk assessments to make sure that they properly consider the needs of each individual. This will help staff to work consistently in providing good, safe care, based on an individual care plan. The way staff handle people’s medication must be checked more thoroughly, to reduce the risk of people getting medication that they no longer need, having to do without medication which has run out, or of receiving medication which may no longer work to it’s full potential. To keep people protected from unsuitable workers: • Staff must not be deployed until proper recruitment checks have been completed, including two written references, one from the most recent employer. Where staff are deployed following a POVAFirst check, they must be Version 5.2 Page 27 Timescale for action 30/09/08 2 OP9 13 30/09/08 3 OP29 19 28/08/08 • The Rambla Nursing Home DS0000071488.V371131.R01.S.doc 4 OP38 13 supervised at all times until such time that the full Criminal Records Bureau check is returned and reviewed. Written confirmation must be kept to show that bed safety rails are checked regularly by someone suitably trained to do so. This will confirm that they are maintained in good safe working order. 28/08/08 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 OP7 Good Practice Recommendations Plans to make people’s care records more individual should be put into action. Where possible, they should be developed with input from the person, and their relatives if appropriate. It would be good practice to give people a list of forthcoming activities, so they are able to choose what they want to attend in advance. There should be a written menu for each mealtime which offers people a good choice and variety of meals in advance of the mealtime. Consideration should be given to surveying people to seek their views about the menu to establish what, if any, changes they would like to see. Staff should be given a means of recording complaints formally, so that important information raised with them is not lost. Any decisions reached and agreed with the fire officer about fire safety, and people’s personal wishes and preferences with regards to their bedroom doors, should be recorded in the fire safety risk assessment so it is available for consideration when the assessment is reviewed in the future. Serious thought should continue about how staffing levels DS0000071488.V371131.R01.S.doc Version 5.2 Page 28 2 3 OP12 OP15 OP33 4 5 OP16 OP19 6 OP27 The Rambla Nursing Home OP33 7 OP38 can be adjusted to benefit people. As part of this, consideration should be given to surveying people about where they think there are shortfalls. This would help to make sure that adjustments are made in accordance with their views. Cleaning records should be devised which require staff to sign when they have completed a cleaning task. This would make the audit of the kitchen easier, and would be a better way of calculating whether extra kitchen support is required in maintaining an organised environment for the preparation of food. The Rambla Nursing Home DS0000071488.V371131.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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 The Rambla Nursing Home DS0000071488.V371131.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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