Inspection on 12/02/09 for The Ranch

This is the latest available inspection report for this service, carried out on 12th February 2009.

CSCI found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

The Ranch 23/02/07

The Ranch 24/01/06

The Ranch 14/12/05

The Ranch 28/02/05

The Ranch 06/01/05

Similar services:

Southfields

Thorndene

Insight - Eastchurch

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

1 Marten Road

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: The Ranch Well Path, Well Lane Horsell Woking Surrey GU21 4PJ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Lesley Garrett     Date: 1 2 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 25 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 25 Information about the care home Name of care home: Address: The Ranch Well Path, Well Lane Horsell Woking Surrey GU21 4PJ 01424438813 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : isaactagoe.questhaven@gmail.com Quest Haven Ltd care home 3 Number of places (if applicable): Under 65 Over 65 0 0 learning disability mental disorder, excluding learning disability or dementia Additional conditions: Date of last inspection Brief description of the care home 3 3 The Ranch is a detached bungalow situated within a quiet residential area of Woking. The home provides 3 single bedrooms two of which have en-suite facilities, a communal bathroom, lounge, and conservatory, dining area, kitchen, office, utility room and a small rear garden. There is ample parking space to the front and side of the property. Local transport links provide access to Woking and surrounding areas. Care Homes for Adults (18-65 years) Page 4 of 25 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This inspection of the care home was an unannounced Key Inspection. Mrs L Garrett, Regulation Inspector, carried out the inspection and the registered manager, who is also a director of the company represented the service. The inspector arrived at the service at 10:30 and was in the home for two and a half hours. It was a look at how well the home is doing. It took into account information provided by the home and any information that CSCI has received about the service since the last inspection in February 2008. The manager had supplied CSCI with an Annual Quality Assurance Assessment (AQAA) prior to the key inspection. We looked at how well the service was meeting the key national minimum standards and complying with the regulations and has in this report made judgements about the Care Homes for Adults (18-65 years) Page 5 of 25 standard of the service. Documents sampled during the inspection included the homes care plans, risk assessments, daily records, some policies and procedures and staff employment records. We also spent time with the people using the service to seek their views. From the evidence seen by the inspector and comments received, the inspector considers that the home would be able to provide a service to meet the needs of individuals who have diverse religious, racial or cultural needs. No complainant has contacted the commission voicing concerns about the service. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 7 of 25 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 8 of 25 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People wishing to use the service have their needs assessed prior to admission to ensure the service can meet their needs. Evidence: The homes Statement of Purpose and Service User Guide have been updated in 2009. Both documents are well written in plain English and include pictures to assist people in making a choice if they wish to live at the home. The home has an admission and assessment procedure, which ensures that all prospective people wishing to use the service have a care needs assessment prior to admission to the home to ensure that the home will be able to meet the individuals needs. The home currently has one vacancy and the manager confirmed that he would undertake any assessments prior to individuals moving to the home. Care Homes for Adults (18-65 years) Page 9 of 25 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service have care plans and risk assessments in place which are reviewed every month and contain enough detail to enable staff to adequately care for the needs of the people living there. Evidence: Both people living at the home have a care plan, which the home refers to as protocols. Since the last inspection the protocols have been separated into two individual folders. Both protocols were looked at by the inspector and they were clearly written to describe the individualised personal care needs and how care and support were provided taking into account the persons choices and preferences on how they liked to receive care and support for example times of getting up and going to bed and their likes and dislikes. Care Homes for Adults (18-65 years) Page 10 of 25 Evidence: The protocols detailed the peoples religion, next of kin or significant people in their life, and their current medication. Daily records written by staff were looked at and included reporting on their daily activities, their interactions, achievements and general demeanour throughout a twenty - four hour period. There was evidence in the protocols to indicate that formal and informal reviews of the care provided to the people using the service had been held every month in order to make sure that the home continues to meet their needs since they came to live at the home. The protocols had all been agreed by the people using the service and staff. The protocols also contained some risk assessments, which documented potential hazards in the peoples daily lives for example having a cigarette, using the kitchen and road safety. During the inspection the people using the service told us that they are always given choices in their daily lives. Choices they told us about included going to bed and getting up in the morning and the food they would like to eat. Care Homes for Adults (18-65 years) Page 11 of 25 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are supported to make choices about their lifestyle and their recreational activities and this is all documented in their protocols. Evidence: On the day of inspection the manager was on duty with another member of staff. The protocols looked at during the inspection evidenced that both the people are involved in daily living skills which include house work for example wiping up the dishes, keeping their bedrooms tidy, using the vacuum cleaner, cooking meals with help, doing their laundry and shopping for household groceries. One person was pleased to show us that she had her washing in the laundry ready to do it that week. Both people using the service were home on the morning of inspection with one person attending college in the afternoon. Care Homes for Adults (18-65 years) Page 12 of 25 Evidence: Both people using the service told us that they are able to keep in touch with people who they want to and that the staff and the manager are nice and they feel well looked after. The inspector saw some records from family and looked in the visitors book and the daily diaries which showed that people are encouraged and supported to keep in contact with people close to them and can also use the homes telephone if they choose. The manager said that both people have regular visits from their family and they told the inspector that they look forward to these visits. Both people using the service told us that they had been home to their families for Christmas and had enjoyed themselves. The home has a system of recording peoples activities using a tick box form called Opportunistic Plans. Staff members complete the form by using a tick if the client takes part in any activities, which would include daily living skills and social activities. The home has written menus to offer what was considered a well-balanced meal with healthy eating options. All meals are home cooked with an alternative option available for each mealtime. Mealtimes can be varied and the home has made arrangements that people can have their meals in the dining area or on their own if they prefer. The manager said that the menus had been seen by the dietitian for approval regarding the content. One person using the service had been on a reducing diet and records confirmed that they had managed to maintain their weight. The dining area is located in the conservatory of the home, which was observed as spacious, bright and well decorated. No formal meals were observed during the inspection. The homes fridges and pantry were well stocked with fresh vegetables and fruit. Special diets can be are provided and drinks and snacks were seen to be available at all times. Care Homes for Adults (18-65 years) Page 13 of 25 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. All people using the service receive support for their personal care needs and the home ensures that each individual has access to healthcare support when required. Evidence: The protocols had been developed from the available pre assessment records and included the peoples care and support needs. The protocols were well written to allow the reader to gain a good overview of the individuals medical, social and personal care needs including complexities in their mental and physical wellbeing. Due to some peoples complex needs the manager said that the protocols had been developed with the peoples families and other health care professionals involvement where possible. The homes diary and opportunistic plans evidenced that regular and appropriate health care appointments are attended including visits to the individuals General Practitioner (GP) when necessary. Through looking at records it was evident that the home has maintained good working partnerships with health care professionals which Care Homes for Adults (18-65 years) Page 14 of 25 Evidence: included opticians, dentists, chiropodists, and ongoing psychiatric/psychological support when required to ensure that the peoples health care needs continue to be met. The manager said that both people have appointments every three months at the hospital to see a specialist. The home has a monitored dosage system in place for the administration of the medications. All medication administration records were fully completed with no gaps seen. The home has good, clear procedures in place for the monitoring and recording of all medicines administered and those entering and leaving the home. Staff training in medication has been conducted and, since the last inspection, there are clear procedures in place for the administration of the as required medication. Care Homes for Adults (18-65 years) Page 15 of 25 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service can be confident that their complaints would be listened to and that they are protected from abuse. Evidence: The home has an established complaints procedure. The manager told the inspector that any complaints received by the home would be fully investigated using the homes complaints procedure. The manager said that he had not received any complaints since the last inspection. One person using the service confirmed to us that they would know who to make a complaint to and explained how they would do this. The home has a copy of the local authoritys safeguarding procedures for the protection of vulnerable adults. The homes managing abuse policy has been reviewed and amended to comply with the local authoritys procedures.There have been no safeguarding alerts made by the home. Care Homes for Adults (18-65 years) Page 16 of 25 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service provides a safe, well-maintained, comfortable environment for the people using the service. Evidence: The home provides a homely environment for people. The premises were viewed as well decorated, comfortable, bright, airy, clean and free from offensive odours. Security lighting is installed to the outside of the building to help the people feel safe. Both people using the service were pleased to show us their bedrooms. They were well decorated and contained a variety of personal items and were appropriately furnished. The home has a weekly cleaning schedule, which takes into account the guidelines for infection control. Hand towels and soap is now available following the last inspection.It was observed that the carpet in the conservatory was stained. The manager said that the light colour of the carpet showed marks very quickly and that is it cleaned regularly every six months. He stated that he would arrange for this carpet to be cleaned earlier. Care Homes for Adults (18-65 years) Page 17 of 25 Care Homes for Adults (18-65 years) Page 18 of 25 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A competent and qualified staff team supports the people who use the service and the homes recruitment procedures protect them. Evidence: The home employs seven care staff who between them work full or part time shifts.The people spoken to on the day of inspection were complimentary about the staff and the care they received. Both people using the service knew who their key worker was. On the day of the inspection one member of staff was completing a pedicure for one of the people. Both people told us that they enjoyed this activity. The home had a relaxed atmosphere and the staffing levels of the home were evidenced and considered adequate to meet the current needs of the people using the service. Two staff recruitment files were viewed. Both files contained all items required under the Care Homes Regulations 2001 to employ staff safely at the home. One staff file contained two references but neither were from their previous manager. This was discussed with the manager who will ask the member of staff to provide the name of their previous manager and will try now to apply for that reference. Care Homes for Adults (18-65 years) Page 19 of 25 Evidence: It was demonstrated that all staff receive induction prior to working in the home and that regular supervision sessions take place and appraisals every year. The Annual Quality Assurance Assessment (AQAA) received by the commission details that the care staff were working toward achieving or had achieved their National Vocational Qualification (NVQ) level 2 or 3 in care. Those that were studying their level 3 last year have now completed it successfully. Care Homes for Adults (18-65 years) Page 20 of 25 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service benefit from good management arrangements and that they are consulted about the running of their home. Health and safety checks have now improved. Evidence: The registered manager is a trained learning disability nurse (RNMH) who keeps his professional registration up to date, along with continuing his professional development. He has completed the NVQ Registered Manager Award (RMA). It was observed on the day that the manager and people using the service were relaxed in one anothers company and had good communication between them throughout the day. It was noted that the other staff member had a good rapport and knowledge of the people and were seen to listen to their views and opinions. People using the service told us that they have regular meetings with the staff and minutes were kept which we observed. Formal reviews also take place at least every six months where relatives are Care Homes for Adults (18-65 years) Page 21 of 25 Evidence: also invited to take part.Regulation 26 visits take place every month and these visits are documented and records available at the home. The manager said that each person has a bank account and, with support, they can go to the cash machine to withdraw their money when ever they like to. Money can be given to the manger for safekeeping and in those circumstances receipts are kept and transactions signed for. Records indicated that health and safety checks are maintained and certificates are kept. During the last inspection requirements were made in respect of the fire arrangements. The manager has now contacted the local fire officer and this requirement has now been met. The bath water temperature in the communal bathroom has now been reduced to a safe level. Care Homes for Adults (18-65 years) Page 22 of 25 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 23 of 25 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 24 of 25 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 25 of 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!