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Inspection on 26/10/07 for Welcome House - Ruby Lodge

Also see our care home review for Welcome House - Ruby Lodge for more information

This is the latest available inspection report for this service, carried out on 26th October 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Ruby Lodge provides a supportive environment for up to 17 people who suffer with mental health issues. The organisation has introduced a programme of maintenance in the home, which has improved the general ambience of the environment. Service users have access to and participate in a range of activities in and out of the home. Two residents have been enabled to pursue their artistic hobbies and the home has provided sheds for them to work in and store their equipment. The Registered manager maintains all records and documents to a good standard. A systematic review of all care and support plans has been completed and these records set out clearly the needs of service users and guide staff in supporting them. All of the residents spoken to said that the quality of food in the home is good and that they are involved in the planning and preparation of meals. The home recognises equality and diversity issues and supports people of different faiths to pursue their religions and respects individual cultural and religious needs.

What has improved since the last inspection?

The Registered Manager has completed a comprehensive review of all service user`s individual support plans, which provide clear guidance and take into account risk factors associated with each individual. The organisation has invested in the redecoration of the home. There is an ongoing programme of redecoration and renewal, which is close to completion. The home has continued to support residents to find and participate in a range of activities outside of the home.

What the care home could do better:

Only one recommendation has been made in respect of this inspection process. This relates to the development of support plans promoting independent living skills, which should provide guidance and measurable targets to enable residents to achieve these goals.

CARE HOME ADULTS 18-65 Welcome House - Ruby Lodge Ruby Lodge 58 Pelham Road Gravesend Kent DA11 0HZ Lead Inspector Joseph Harris Key Unannounced Inspection 26th October 2007 10:30 Welcome House - Ruby Lodge DS0000023771.V352150.R01.S.doc Version 5.2 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 Welcome House - Ruby Lodge DS0000023771.V352150.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 Adults 18-65. 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. Welcome House - Ruby Lodge DS0000023771.V352150.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Welcome House - Ruby Lodge Address Ruby Lodge 58 Pelham Road Gravesend Kent DA11 0HZ 01474 355594 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) whrubylodge@aol.com Dr Toqeer Aslam Ms Teresa Moss Care Home 14 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (14) of places Welcome House - Ruby Lodge DS0000023771.V352150.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12th June 2006 Brief Description of the Service: Ruby Lodge is a large detached property situated on the outskirts of Gravesend. The home is owned by Welcome House whose offices are situated in Walderslade, Chatham. The home is registered to provide personal care and support for up to 17 people with a mental disorder. There are currently 15 service users living at the home. The service user guide, statement of purpose, and reports from the Commission for Social Care inspection are available to service users and are kept in the office. Weekly fees are £560. Purchasers of the service will be given a full breakdown of the fees charged. The home is staffed 24 hours. There is a registered manager and a team of support staff. Accommodation is set over three floors. Eleven rooms are for single occupancy, and there are three shared rooms. There is a large lounge, smoking room, and separate dining room on the ground floor. Service users have access to a large garden at the rear of the property. The office is at the end of the garden in a purpose built structure. There is limited parking at the front of the house. Ruby Lodge is close to several local amenities and a bus route. Service users are able to access local community resources as they wish. Welcome House - Ruby Lodge DS0000023771.V352150.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key unannounced inspection process culminated in a site visit to the home on 26th October 2007. The site visit commenced at approximately 10.30am and concluded at 4.30pm, lasting for around 6 hours. During the course of the visit a tour of the premises was undertaken and discussions were held with the registered manager, staff members and service users. A range of documentation was examined relating to the residents, staff, medication, health and safety and the day-to-day running of the home. The home also returned the Annual Quality Assurance Assessment (AQAA), which provides information to inform the inspection process. What the service does well: What has improved since the last inspection? The Registered Manager has completed a comprehensive review of all service user’s individual support plans, which provide clear guidance and take into account risk factors associated with each individual. The organisation has invested in the redecoration of the home. There is an ongoing programme of redecoration and renewal, which is close to completion. The home has continued to support residents to find and participate in a range of activities outside of the home. Welcome House - Ruby Lodge DS0000023771.V352150.R01.S.doc Version 5.2 Page 6 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. Welcome House - Ruby Lodge DS0000023771.V352150.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Welcome House - Ruby Lodge DS0000023771.V352150.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. Prospective service users have an assessment of their needs completed prior to moving into the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Prior to any prospective service user moving into Ruby Lodge the Registered Manager requests pertinent information from the referrer including Care Programme Approach (CPA) care plans and risk assessments and any joint assessments completed by health and social services. The Manager or Senior Staff then aim to visit the individual in their current accommodation completing their own assessment. A trial visit is then arranged to the home and further visits can be arranged to suit the needs of the individual. On deciding to move in a plan of care is developed including relevant risk assessments and the placement is for an initial 12-week trial period following which a multidisciplinary review meeting is held to confirm the placement and address any issues that may arise. Two service user files were examined relating to people who had moved in recently, which demonstrated that the admission process is appropriately followed and any concerns or service limitations are addressed. Welcome House - Ruby Lodge DS0000023771.V352150.R01.S.doc Version 5.2 Page 9 Welcome House - Ruby Lodge DS0000023771.V352150.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. Quality in this outcome area is good. A plan of care and support is developed for each service user including and assessment of risk factors. Residents are able to exercise choice and autonomy in their daily lives. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three individual service user plans were examined through the course of the site visit ranging from relatively new service users to people who have lived in the home for a number of years. The Registered Manager has completed a review of all individual plans and has updated each one. The information contained within the files is linked to any relevant assessments and clearly sets out the needs, aims and goals of each resident. There are appropriate levels of guidance to enable staff to meet the assessed needs in a consistent manner. All plans are reviewed on a regular basis. A discussion was held with the Welcome House - Ruby Lodge DS0000023771.V352150.R01.S.doc Version 5.2 Page 11 Manager regarding the developing of support plans to enable residents to address independent living issues. It is recommended that support plans are set out providing clear guidance and measurable targets to determine progress in promoting independent living skills. Refer to recommendation 1. The majority of service users manage their own finances on a weekly basis. Some individuals have an appointed representative independent of the service where issues of capacity are present. The home has assisted service users to access advocacy support and promotes individual responsibility for activities of daily living with staff providing support as required. Risk assessments are developed for each individual service user. The information is based on CPA risk assessments, past history and other factors. The risk assessments examined clearly stated risk factors and measures to minimise the perceived risks. Service users are consulted and asked to sign all care plans and risk assessments. Welcome House - Ruby Lodge DS0000023771.V352150.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17. Quality in this outcome area is good. Residents have access to therapeutic, recreational and meaningful activities. Equality and diversity issues are recognised and individual rights are respected. The home offers a healthy, balanced diet. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents stated that they are happy with the range of activities available to them in and out of the home. A number of residents pursue active hobbies such as painting, sculpting, DIY and knitting amongst other things. The home has erected two sheds specifically to enable service users to pursue their hobbies. The local area is, reportedly, well served for resources and activities. There are a number of resources specifically for people with mental health issues including supported learning, work training, drop-in centres and a Welcome House - Ruby Lodge DS0000023771.V352150.R01.S.doc Version 5.2 Page 13 community mental health centre. One resident is in the process of applying for voluntary work with the local police force. Residents are encouraged to take ownership of the home through regular house meetings and an expectation to be involved in daily chores, cleaning, cooking and shopping. The majority of residents access the community independently, although staff are available to support people if desired. One resident said, “I like to stay in most of the time and stay warm.” Another person said, “I go out nearly every day to see friends or do a bit of shopping.” The home supports people of different faiths and ethnic backgrounds to have a lifestyle that enables them to pursue their beliefs and recognise their cultural differences. Visitors are welcomed into the home at all reasonable times, although there is an awareness that should a visitor’s behaviour impact on the well-being of an individual restrictions may be applied in consultation with all appropriate people. Service users plan and organise their own time as much as possible. Staff respect individual rights to get up and go to bed when they choose. Residents said that they are able to choose how they spend their time and staff support them in these decisions. All of the residents spoken to said that the food is good in the home. People confirmed that they are included in the planning and preparation of meals and that a choice of meals is always available. The home has a good-sized domestic-style kitchen and was well stocked on the day of the site visit. Staff reported that there is an adequate budget for purchasing food. One resident said, “I like it when we have take away nights.” Another person said, “ We had a curry cooked by one of the residents recently, it was excellent.” Welcome House - Ruby Lodge DS0000023771.V352150.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. Quality in this outcome area is good. Resident’s health and personal care needs are appropriately addressed. Medication processes are well managed in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The vast majority of service users in the home require minimal support in relation to personal care and staff support individuals mainly through encouragement. Residents commented that they felt supported by staff and that their privacy and dignity is upheld. Healthcare records are well maintained providing information about appointments and consultations and including any relevant outcomes. All residents are registered with local GPs and there is reported to be very good support from the local community mental health team. All service users have an annual health check-up with their GP. Medication processes are well established in the home. All staff are given medication training prior to administering and the Registered Manager Welcome House - Ruby Lodge DS0000023771.V352150.R01.S.doc Version 5.2 Page 15 periodically completes staff competency questionnaires to ensure knowledge and skills are retained. The medication storage facilities are appropriate for the needs of the home and all administration records and documentation was up to date. Medication is stored in an orderly fashion. There is evidence that the home supports residents to ensure regular reviews are carried out by a Responsible Medical officer. Welcome House - Ruby Lodge DS0000023771.V352150.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is good. Appropriate systems are in place to enable service users to voice any concerns and complaints and to protect the safety of individuals from forms of abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The company has a clear complaints process meeting all relevant requirements. The registered Manager aims to deal with any concerns or issues in the home on an informal basis in the first instance with recourse to the formal process if required. Service users stated that they feel comfortable raising any concerns either on a 1:1 level at weekly keyworker meetings, through house meetings or informally with staff. There have been no complaints since the last inspection. All staff address abuse and adult protection issues through the home’s induction programme and additional training that is provided by the company as mandatory for all staff. The manager and staff demonstrated a good awareness of issues surrounding this topic. There have been no adult protection alerts raised since the last inspection. Welcome House - Ruby Lodge DS0000023771.V352150.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. Quality in this outcome area is good. The home environment is suitable for the needs of the service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A tour of the premises was undertaken including all communal areas and a selection of bedrooms. There are 3 double bedrooms in the home and residents that currently share stated that they are happy to continue doing so. The house is arranged over three floors with most bedrooms located on the first floor. There is a large open plan lounge, a quiet room and a good-sized dining area. The kitchen and laundry facilities are domestic in scale and suitable for the needs of the home. There are sufficient numbers of toilets and bathrooms suitably located around the building. A large garden is to the rear of the property, which has two sheds Welcome House - Ruby Lodge DS0000023771.V352150.R01.S.doc Version 5.2 Page 18 and an office located in it. The sheds are used for service users to store tools and work on their hobbies. A programme of renewal and redecoration is on-going within the property with the majority of rooms having now been redecorated. It was reported that the home meets all regulations as set out by the environmental health and fire departments. Welcome House - Ruby Lodge DS0000023771.V352150.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35. Quality in this outcome area is good. Staff receive all required training and demonstrate competency in their roles. Recruitment checks are appropriately carried out. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All of the staff within the home have achieved or are working towards a National Vocational Qualification (NVQ) in care. Over 50 of the staff team have already achieved an NVQ level 2 or above. In discussion with staff it was evident that a sound understanding of knowledge base was present regarding issues surrounding mental health and the individual needs and requirements of service users. The organisation has recently improved the level of training offered and is now using an external training agency to provide courses in key competency areas. All mandatory training is up to date for the staff team and additional course covering a range of relevant topics are also available. Service users are also encouraged to participate in training on topics such as fire safety and first aid. Welcome House - Ruby Lodge DS0000023771.V352150.R01.S.doc Version 5.2 Page 20 The home has introduced the Common Induction Standards based on Skills for Care guidance. This programme is used alongside the home’s own induction pack. The Registered Manager also ensures that all staff complete competency questionnaires covering key topics on a periodic basis. Two staff personnel files were examined, which demonstrated that all required checks and measures are considered prior to appointing a new staff member including two written references, POVA and CRB checks and proof of identity. Welcome House - Ruby Lodge DS0000023771.V352150.R01.S.doc Version 5.2 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42. Quality in this outcome area is good. The home is well run in the best interests of the service users. Health, safety and welfare issues are appropriately managed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Registered Manager has been in post for around four years and demonstrates a positive attitude towards the management of the home. Staff and service users commented about her approachability and one staff member said, “this is a happy house to work in, everyone gets on.” The Registered Manager maintains the administration of records and documents well and responds well to advice from statutory agencies. Welcome House - Ruby Lodge DS0000023771.V352150.R01.S.doc Version 5.2 Page 22 The organisation has developed good quality assurance processes, which include regular monthly monitoring visits from a senior manager, satisfaction questionnaires for service users, relatives and professionals that are collated into an annual report. The home also undertakes a range of regular audits covering health and safety issues and medication amongst other things. Service users have opportunities to raise issues through house meetings and 1:1 keyworker sessions. The Registered Manager ensures that all health and safety issues are monitored and addressed appropriately. All relevant documentation was in place and up to date including service maintenance certificates such as NICEIC electrical wiring and gas safety. An accident record is maintained and fire safety logs kept up to date. Environmental risk assessments are completed and reviewed regularly. Staff have received necessary training and policies and procedures are in place covering safe working practices. Welcome House - Ruby Lodge DS0000023771.V352150.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Welcome House - Ruby Lodge DS0000023771.V352150.R01.S.doc Version 5.2 Page 24 No Are there any outstanding requirements from the last inspection? 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 YA6 Good Practice Recommendations To consider developing measurable and achievable support plans addressing independent living skills for each service user. 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