Inspection on 25/03/08 for 361 The Ridge

This inspection was carried out on 25th March 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 13 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

361 The Ridge 07/03/07

361 The Ridge 08/08/06

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Insight - Eastchurch

Southfields

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Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 361 The Ridge 361 The Ridge Hastings East Sussex TN34 2RD Lead Inspector Niki Palmer Unannounced Inspection 25 March 2008 10:40 th 361 The Ridge DS0000065396.V359109.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 361 The Ridge DS0000065396.V359109.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. 361 The Ridge DS0000065396.V359109.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 361 The Ridge Address 361 The Ridge Hastings East Sussex TN34 2RD 01424 755803 01424 756941 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) www.caremanagementgroup.com Care Management Group Ltd Mrs Patricia Turner Care Home 10 Category(ies) of Learning disability (10) registration, with number of places 361 The Ridge DS0000065396.V359109.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Learning Disability (LD) The maximum number of service users to be accommodated is 10. Date of last inspection 7th March 2007 Brief Description of the Service: 361 The Ridge is a care home, which provides personal care and accommodation for up to 10 people with learning disabilities who may present with associated physical needs including age related conditions. The home is owned and run by Care Management Group (CMG) who are a large national organisation. The home is a large detached property, which is located on a main road on the outskirts of Hastings. There is nearby access to local amenities including shops and leisure facilities and to public transport. Some car parking is available at the home. The building was upgraded and totally refurbished to a high standard, before the first resident was admitted in November 2005. Accommodation is provided over two floors comprising of 10 single rooms all with en-suite facilities. In addition there are three communal bathrooms all with overhead tracking hoists. The home has a good-sized lounge/through dining area and separate kitchen. There is a passenger shaft lift available to allow access to both floors. The home provides personal care and support to residents who are funded by Social Services. The home’s fees as of the day of inspection ranged from between £1200 - £1600 per person per week. Additional costs are charged for hairdressing, toiletries and external leisure activities (£ variable). 361 The Ridge DS0000065396.V359109.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 1 star This means the people who use this service experience adequate quality outcomes. The reader should be aware that the Care Standards Act 2000 and Care Homes Regulation Act 2001, uses the term ‘service user’ to describe those living in care home settings. For the purpose of this report, those living at 361 The Ridge will be referred to as ‘residents’. This unannounced inspection took place on Tuesday 25th March 2008 and lasted six hours. This enabled to Inspector to observe the daily routines and interactions within the home and speak with a number of residents, staff and a visiting District Nurse. Nine residents were living at the home on the day of the inspection, five men and four women aged between 35 and 77 years of age. The first part of the inspection was facilitated by the acting Team Leader, whilst the Registered Manager was available for the latter part of the day. All communal areas and one individual bedroom were seen. Three care records were looked at for the purpose of monitoring care. Other records and documents seen include: the home’s Statement of Purpose and Service Users’ Guide, medication procedures, complaints procedure and the systems in place to safeguard people from harm, staff recruitment checks and the provision of training, the home’s quality assurance systems and some health and safety records. Following the inspection telephone contact was made with the local Community Learning Disability Team (CLDT). An Annual Quality Assurance Assessment (AQAA) was completed by the Registered Manager and returned to the CSCI in October 2007. This gave the service the opportunity to say what the service does well, identify any barriers to improvements that have been faced over the past 12 months and how the service plans to make improvements within the next 12 months. What the service does well: 361 The Ridge offers a friendly and relaxed environment that is kept in good decorative order. It presents as a clean and well-maintained place to live. Feedback from a member of the CLDT was positive. One person said: ‘The home has pulled out all the stops’ for one particular resident. 361 The Ridge DS0000065396.V359109.R01.S.doc Version 5.2 Page 6 Residents and others can be assured that the home will listen to and act upon any concerns or complaints they may have. Residents are protected by the home’s robust recruitment procedures. What has improved since the last inspection? What they could do better: This was the home’s third key unannounced inspection, which identified a number of outstanding serious concerns and unmet requirements: Despite repeated requirements being made at previous inspections and the CSCI reinforcing their concerns to senior representatives of CMG in respect of the home’s inadequate pre-admission assessments and care planning procedures, the Manager accepted a new admission to the home who seriously compromised the health, safety and welfare of others already living at the home. This person was accepted on the basis of an emergency placement without any pre-admission assessment, risk assessments or care plan documentation in place. It was of concern to note that given the home’s history of concerns in respect of the above and previous quality ratings that these matters failed to be identified and appropriately addressed through the home’s own quality assurance systems. In addition, the home’s AQAA was brief and gave very little information about the service or any evidence to support any of the claims made within it. Many areas had been left blank, particularly the ‘What we could do better’ sections. Due to the serious nature of these concerns, a Management Review Meeting was held by the CSCI following the inspection and it was decided that enforcement action would be taken against the home through Statutory Requirement Notices. Therefore requirements in respect of Standard 2 – the home’s pre-admission assessment procedures, Standard 6 – care planning procedures, Standard 9 – risk assessments and Standard 39 – quality assurance systems have not been reflected within this report. 361 The Ridge DS0000065396.V359109.R01.S.doc Version 5.2 Page 7 The home’s compliance with the Statutory Requirement Notices will be monitored by the CSCI within a given timescale and will be reflected in the next inspection report. 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. 361 The Ridge DS0000065396.V359109.R01.S.doc Version 5.2 Page 8 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 361 The Ridge DS0000065396.V359109.R01.S.doc Version 5.2 Page 9 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): 1 and 2. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home’s pre-admission assessment procedures are inconsistent and place those already living at the home at potential risk. EVIDENCE: The CSCI and others (including the local CLDT and Care Managers) have had serious concerns regarding the compatibility of some residents living at the home since the home first opened in November 2005 and following the home’s first key unannounced inspection in August 2006. This was largely due to misleading information contained within the home’s Statement of Purpose and Service Users’ Guide and the home’s poor pre-admission assessment procedures. The Manager confirmed that in response to a requirement made at the last inspection, the Statement of Purpose and Service Users’ Guide have been reviewed and amended to clearly determine and define the range of needs that the care home is intended to meet. It is stated: “361 The Ridge provide progressive and holistic care (maintaining therapeutic approach) to older adults with a primary learning disability, some complex and physical associated needs with the possibility of early onset dementia. 361 The Ridge DS0000065396.V359109.R01.S.doc Version 5.2 Page 10 Residents currently at the service ages range between 60 years and 75 years old”. Following the last inspection, two residents were reassessed by their Care Managers and alternative placements found for them. Whilst this has helped to improve some of the compatibility issues between residents, it was of serious concern to note that the home had admitted a person into the home from another CMG service without an assessment of their needs first being undertaken. This person was accepted as an emergency placement and was only supposed to have been living there for up to a maximum of two weeks (as of the day of inspection they had been living at the home for over just over seven weeks). The person was considerably younger, more able and challenging than all other residents already living at the home. Through discussions with staff and the viewing of care records, it was evident that the decision to move this person into the home at such short notice and without adequate time to assess and plan for their care needs, had placed other more vulnerable residents already living at the home at risk. In subsequent correspondence from the organisation’s Chief Operating Officer, he confirmed that: ‘The home managers …… had discussed whether there would be any areas of risk to other people living at the Ridge from the admission and felt that that would be unlikely …… However to ensure his and other people’s safety, they arranged for 1:1 staffing to be provided …. including a senior member of staff (from the original home) who was very familiar with the service user concerned’. He added; ‘The home manager at the Ridge is very thorough in considering admissions of service users to the home and has two comprehensive files in place of admission assessments of potential service users that she had undertaken in the past year. None of these service users were admitted to the home because of the home manager’s concerns on the grounds of either compatibility or risk to the established service users.’ However, it is clear that the ‘good pre-admission procedure in place’ was evidently not adhered to in the case of the recent ‘emergency placement’ to the home. As the home’s poor pre-admission assessment procedures have been raised at each inspection undertaken since the home first opened (despite assurances from senior representatives that they will review and monitor these processes), the CSCI are addressing this matter through a legal Statutory Requirement Notice. Therefore a requirement in respect of Standard 2 is not reflected within this report. 361 The Ridge DS0000065396.V359109.R01.S.doc Version 5.2 Page 11 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 adequate. This judgement has been made using available evidence including a visit to this service. The home’s care planning procedures are currently unsatisfactory and do not always identify an individual’s personal care needs, decisions and choices. (Residents and staff would benefit from a person centred approach to planning care.) EVIDENCE: Concerns have been raised in respect of the home’s care planning procedures at the last two inspections. The Registered Manager explained that she has implemented a completely revised care planning system for each person since the last inspection. Three care records were requested on the day of the inspection. It was of serious concern to note that there was no plan of care in place for the most recently admitted person, who had been living at the home for over seven weeks on the day of inspection. The only documentation that had been put into place on the day of their admission was a ‘quick guide’ for staff to read, 361 The Ridge DS0000065396.V359109.R01.S.doc Version 5.2 Page 12 which included guidelines for staff to follow in the event of an epileptic seizure occurring and a risk assessment around managing their finances. The home had failed to ensure that risk assessments and guidelines were in place to manage this person’s challenging needs (their primary care need) or take the appropriate action to ensure that all other persons living at the home were safeguarded and protected. All that was written in respect of this was: “Staff must be aware if [the person] is in the room with others”. The use of a service user’s care plan from his previous home is not appropriate and clearly does not reflect his current care and support needs or his present situation. Two other care records were seen. The home now has a separate box file in place for each person, which holds a number of smaller files (nine in total). Due to the number of different recording methods being used, it was not easy for the Inspector (or for a person who is unfamiliar with working with each person, such as new or agency staff) to get a clear overview of individual needs. The most useful of these was noted to be the ‘Essential Lifestyle Plan’, as it gave an overview of some individuals’ likes/dislikes and needs. Although one in particular had failed to highlight what sort of things are important to that person in order to reduce the effects of their behaviours that seriously impact on their daily living. This was discussed in detail on the day of inspection, including how staff could support residents to participate more in the day-to-day routines within the home (discussed further under the ‘Lifestyle’ section of this report). Whilst the evident transition to person centred care plans is to be welcomed, it is important that individual files be organised, well maintained and ‘user friendly’, to ensure that personal details and other information, including guidance for staff, is accurate, up to date and readily accessible. Feedback from residents and staff and observations regarding how they are supported to make decisions each day was variable, although it is recognised that due to the cognitive abilities of some this may often be difficult for care staff to facilitate. A concern was raised however in respect of a signed document that was seen in one person’s care records in relation to the monitoring of their diabetes (further discussed under ‘Health and Personal Care’). Whilst risk assessments were seen in the two care records looked at for most activities of daily living, it was noted that the majority are CMG standardised templates and are therefore not specific to individual needs e.g. for the management of diabetes it was stated that the person should be supported with their medication (however, neither of the residents who have diabetes require any medication). 361 The Ridge DS0000065396.V359109.R01.S.doc Version 5.2 Page 13 In light of the concerns that have been raised during this and previous inspections in respect of the home’s care planning and risk assessment procedures, these matters are being dealt with separately from this inspection report through Statutory Requirement Notices. Therefore a requirement in respect Standards 6 and 9 are not reflected within this report. 361 The Ridge DS0000065396.V359109.R01.S.doc Version 5.2 Page 14 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 adequate. This judgement has been made using available evidence including a visit to this service. Residents are not always involved in meaningful daytime activities of their own choice and according to their individual interests. EVIDENCE: Feedback received from Care Managers and other frequent visitors to the home about the provision of daily activities was variable. One person said that each time they visit the home, some people are always sat in the same place with staff talking amongst themselves, whilst another person commented that staff interactions with residents is improved over recent months. Only one person continues to have any structured day service provision in place. On the day of inspection, all residents were at home. Some were watching TV whilst another person was knitting. Staff said that two were meant to have gone out earlier in the day, but that the Team Leader had advised against this due to the arrival of the Inspector. When this matter was raised with the 361 The Ridge DS0000065396.V359109.R01.S.doc Version 5.2 Page 15 Manager of the service, she promptly arranged for residents to be taken out later in the afternoon. The home has an ‘activities board’ in the main living area, which contains photographs of past events and activities. The Inspector recommends that that the home consider making this board more user-friendly and meaningful to residents, e.g. by using photographs and/or pictures of forthcoming events, photos of staff to show who is on duty and when and what choice food is available each day. Care staff said that the home does have access to it’s own transport, but that at present only two staff are able to drive it. This limits the activities that residents can take part in outside of the home, although staff did say that they do on occasions make arrangements in advance for taxis to be booked to take residents shopping or to the pub. The Inspector raised concerns about the lack of activities in respect of two particular residents (concerns that have been raised at previous inspections). One person continues to spend the majority of their time alone in their bedroom, although staff do undertake checks every 30 minutes. When these matters were raised with staff, they were initially quite defensive and responded saying: “He’s very difficult to motivate” “He never wants to join in” “It’s his choice” The second person was observed to pace around the home due to their longterm history of anxiety and associated institutionalised behaviours (in between moments of sleeping in the lounge). When these concerns were raised, the Manager tried to demonstrate to the Inspector the difficulties the staff team have in trying to engage this person in activities, by offering him a box of toys to play with on several occasions, which he did not want to do (this activity was clearly not one that was important or meaningful to that person). After a short period of time, the Manager suggested that they be supported to write a letter to one of his relatives, to which he responded positively, although this was quickly forgotten and the person was asked if they would like some help to complete a jigsaw instead. Through in depth discussions with the staff team, it emerged that a lot more could be done by staff to engage this person (and others) in a number of different activities within the home. A requirement has been raised in respect of this. The manager confirmed that: ‘It is standard practice in the home for service users to be actively supported in meal preparation.’ (All meals are prepared within the home by care staff.) Recommendations have been made at 361 The Ridge DS0000065396.V359109.R01.S.doc Version 5.2 Page 16 previous inspections for the home to consider different ways in which residents can be supported to be more involved in meal planning e.g. by working with residents, as part of an activity to devise colourful pictorial menus for the week (as the reading ability of the residents is variable) or by helping to lay the table and clear away after each meal. There was no evidence of this happening in practice on the day of inspection. 361 The Ridge DS0000065396.V359109.R01.S.doc Version 5.2 Page 17 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 adequate. This judgement has been made using available evidence including a visit to this service. Residents’ healthcare needs will be better met by care staff once they have received the appropriate training. Residents are protected by the home’s practices for the safe handling of medicines. EVIDENCE: All residents are registered with a local GP and dentist and members of the CLDT confirmed that the home is good at liaising with them as necessary. Concerns have been raised at previous inspections in respect of how the home looks after people with additional healthcare needs such as epilepsy and diabetes. It was pleasing to note that a member of staff confirmed that epilepsy training had recently been provided by the CLDT and that she would feel confident in supporting residents in the event of a seizure occurring. However, concerns were raised once again in respect of how the home supports people with diabetes: Two people living at the home have diet-controlled diabetes, which is overseen by a District Nurse. An immediate requirement was issued at the last 361 The Ridge DS0000065396.V359109.R01.S.doc Version 5.2 Page 18 inspection in respect of how care staff were monitoring one person’s blood sugar levels. Whilst the Manager reported that this particular issue of poor practice had ceased, the person’s care plan had not been updated in respect of this. This person had however, been asked to sign a consent form in respect of his diabetes, which stated: “I do not understand the reason, but I do understand that this needs to be done and give my consent”. It was of concern that there was no written evidence or documentation to explain how this decision had been reached or that care staff had taken the time to explain their individual healthcare needs to them. This suggests that care staff have little understanding and knowledge of the Mental Capacity Act and/or individuals’ rights and capacity to make an informed decision to consent to treatment. In addition, a District Nurse commented that care staff are not always picking up on and reporting potential problems to her or the surgery promptly. Staff said that they would benefit from additional training in the care and management of diabetes. The home’s medication records and storage systems were inspected. The home uses a pre-packed blister pack issued by the local pharmacy, which is easy to use and monitor. Only members of staff who have received training and been assessed as competent in the administration of medicines are able to carry out this task (records of individual competency assessments were seen in some staff files). Senior members of staff are responsible for the reordering and returning of medicines to the pharmacy. Medication practices were found to be good and in response to a requirement made at the last inspection, staff are now clearly recording the reasons as to why some medicines have not been given e.g. if a person refuses. 361 The Ridge DS0000065396.V359109.R01.S.doc Version 5.2 Page 19 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 adequate. This judgement has been made using available evidence including a visit to this service. Albeit that systems are in place to support residents and others in raising any concerns, the home fails to ensure that residents are protected from potential harm, neglect or abuse. EVIDENCE: A copy of the home’s complaints procedure is displayed within the home. It is presented in an easy to read and understand format (including colour pictorial symbols). It clearly explains how complaints can be made, who they can be made to and how people can expect the matter(s) to be dealt with. No complaints have been received by either the home or the CSCI since the last inspection. The home has a detailed Safeguarding Vulnerable Adults and whistle-blowing policy and procedure in place in accordance with revised local multi-agency guidelines. These have been simplified and presented in an easy to use flowchart format, which are discreetly displayed throughout the home. Some staff said that they have attended recent training in respect of this, although this is outstanding for some staff (further discussed under ‘Staffing’). Not withstanding the above, the home failed to ensure and protect residents already living at the home by admitting a person with challenging needs into the service without clear assessments and guidelines being in place to ensure their health, safety and protection. Evidence of this was seen on the day of inspection through a number of incident reports completed by staff, which 361 The Ridge DS0000065396.V359109.R01.S.doc Version 5.2 Page 20 showed an increase of verbal and physical aggression within the home towards residents by this person. 361 The Ridge DS0000065396.V359109.R01.S.doc Version 5.2 Page 21 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, 27, 28 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. 361 The Ridge presents as clean and well-maintained. EVIDENCE: All communal areas and one individual bedroom were seen. Accommodation is provided over two floors comprising of 10 single rooms all with en-suite facilities. Four are on the ground floor and six are on the second. In addition to the en-suite facilities, there are three communal bathrooms fitted with height adjustable baths. Overhead tracking hoists are also available to support residents with reduced mobility. All hot water outlets have thermostatic valves fitted to ensure hot water temperatures do not exceed the recommended 43°C. Since the last inspection the staff office and sensory room have been swapped over. The Manager explained that this was because the large sensory room was rarely used (if ever) by residents and that it made more sense for the 361 The Ridge DS0000065396.V359109.R01.S.doc Version 5.2 Page 22 office to be larger to accommodate staff and the storage of records. She confirmed that the old office will be turned into a ‘quiet room’ for residents in due course. The home’s progress with this will be followed up at the next inspection. A recommendation was made at the last inspection for the upstairs training room to be used as an activities room for residents, but this has not been implemented. Staff explained that stair gates are in now in place to make the home safer for residents. This does not impact on their freedom to move around the home as the home has a lift installed, which most residents are able to use with support. The home was found to be clean, tidy and well-maintained on the day of inspection, although some carpeted areas are still in need of replacing (as highlighted at the last inspection). The Manager wrote in the AQAA (dated October 2007) that quotes had been obtained to replace some areas with nonslip vinyl flooring. On the day of inspection, this was still outstanding, although those areas seen were reasonably clean. Staff said that all communal carpeted areas are cleaned weekly and all others as and when. This has not been repeated as an outstanding requirement, but will be followed up at the next inspection. 361 The Ridge DS0000065396.V359109.R01.S.doc Version 5.2 Page 23 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): 31, 32, 34 and 35. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents’ needs are met by sufficient numbers of staff on duty and they are safeguarded by the home’s recruitment procedures. The home’s systems for ensuring that all staff receive regular mandatory training need to be improved to ensure that all staff are competent and qualified to meet the needs of residents. EVIDENCE: In addition to the Registered Manager, the home employs a total of 17 care staff. One of these is an acting Team Leader and four are Senior Support Workers. Only six have achieved at least NVQ Level 2 in Care. There are currently no plans for the remaining staff team to start working towards this qualification. A requirement has been made in respect of this. Staff and others spoken with said that there has been a big turnover of staff since the last inspection, which has improved the overall ethos of the home. One person commented: “We are much better and more focused towards the needs of the residents”. 361 The Ridge DS0000065396.V359109.R01.S.doc Version 5.2 Page 24 Staff and working rotas showed that there are usually three staff on each shift in addition to the Manager and Team Leader (who generally work between the hours of 9am-5pm weekdays. Staffing numbers are sometimes increased to four if there are planned events or trips out. There are always two waking night staff on duty. On the day of inspection it was observed that all staff are now wearing uniforms. Staff said that this decision was reached following infection control training (due to one person’s personal care needs). Staff did say however, that they wear their own casual clothes when supporting residents out into the community. The Manager said that CMG advertise any vacancies in local newspapers, on their website and through job fairs. All initial information is coordinated by the Human Resources department who are responsible for sending out application forms, alongside the required police checks, health declaration and equal opportunities form. The Manager and staff confirmed that there is a selection process in place and that the Manager is involved in this decision making process. Three staff recruitment records were seen. Application forms were sufficiently detailed and there was evidence of police checks, photo identification, two written references and permits to work being obtained prior to employment. Staff spoken with said that when they first started working at the home, they ‘shadowed’ more experienced members of staff for a period of two weeks. The home’s AQAA stated that all new staff are required to complete a Skills for Care induction pack. Copies of these were seen in individual staff files. Staff were generally positive about working for the organisation and said that training opportunities are good. Recent training for some staff includes: epilepsy, manual handling, fire safety and Safeguarding Vulnerable Adults. The home’s training matrix was seen on the day of inspection, which highlighted a number of mandatory training courses that are outstanding. As no dates had been organised to ensure that these shortfalls are not overlooked, a requirement has been made in respect of this. 361 The Ridge DS0000065396.V359109.R01.S.doc Version 5.2 Page 25 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 adequate. This judgement has been made using available evidence including a visit to this service. The home is not always managed effectively and in the best interests of residents. EVIDENCE: Following the last inspection, a new Manager was appointed who registered with the CSCI in January 2008. She has almost 20 years experience in care, during which time she has been employed in a variety of positions including Nursing Auxiliary, Support Worker, Senior Support Worker and as the Registered Manager of a number of services. She has achieved a number of qualifications relevant to her post, including a BTEC in Managing Health & Care Services, NVQ Level 4 in Care and NVQ Level 4 Registered Manager (Adults) Award. 361 The Ridge DS0000065396.V359109.R01.S.doc Version 5.2 Page 26 Whilst feedback from residents, staff and others was generally positive of the way in which some improvements have been noted in respect of how the service is managed, in light of the history of repeated serious concerns that have been raised in respect of the home’s: Inconsistent pre-admission assessment procedures Unsatisfactory care planning and risk assessment procedures Failure to protect the health and welfare of residents A lack of management and leadership support from the organisation The CSCI does not consider that this service is being run and managed in the best interests of residents and therefore enforcement action must be taken. CMG employ their own quality assurance team who visit each of the homes on a monthly basis. The purpose of these visits is to undertake an inspection of the service based on meeting the National Minimum Standards. It was of concern to note that given the home’s history of concerns in respect of the above and previous quality ratings that these matters failed to be identified and appropriately addressed. In addition, the home’s AQAA was brief and gave very little information about the service or any evidence to support any of the claims made within it. Many areas had been left blank, particularly the ‘What we could do better’ sections. A small number of health and safety records were seen during the inspection. These confirmed that all appliances and regular health and safety checks including fire-fighting equipment are frequently carried out. 361 The Ridge DS0000065396.V359109.R01.S.doc Version 5.2 Page 27 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 3 2 1 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 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 3 29 X 30 3 STAFFING Standard No Score 31 3 32 2 33 X 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 1 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 X 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 3 X 2 X 1 X X 2 X 361 The Ridge DS0000065396.V359109.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? Yes 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 YA7 YA18 YA19 Regulation 12(1)(2)(3) Requirement That all staff have an understanding of and respect residents’ rights to making decisions in respect of the of the law, learning disabilities and the Mental Capacity Act. That all residents are encouraged and supported to take part in a variety of meaningful activities both within and outside of the home. These must based on individual needs and preferences; and Be reflected in individual plans of care. 3. YA18 YA19 YA35 12(1)(2)(3) 13(1) 18(1)(a)(c) (i) That all staff are appropriately trained in the care and management of diabetes. Any concerns in respect of residents’ healthcare matters must be reported to the relevant healthcare professionals without delay. That at least 50 of care staff DS0000065396.V359109.R01.S.doc Timescale for action 30/06/08 2. YA12 YA13YA16 16(2)(m) (n) 30/06/08 30/06/08 4. YA32 18(1)(a)(c) 30/09/08 Page 29 361 The Ridge Version 5.2 (i) are trained to or are working towards achieving NVQ Level 2 in Care. That systems are in place to ensure that all staff receive mandatory training in the following areas: - Safeguarding Vulnerable Adults from Abuse - Fire safety - Health and Safety 30/06/08 5. YA23 YA35 YA42 13(6) 18(1)(a)(c) (i) 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 YA12 YA17 YA31 Good Practice Recommendations That the activities board in the main living area is made more user-friendly and meaningful for residents including: - Forthcoming daily events and activities - What choice of food is available each day - Which staff are working and when. 361 The Ridge DS0000065396.V359109.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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. 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