Inspection on 07/03/07 for 361 The Ridge

This inspection was carried out on 7th March 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 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 11 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

361 The Ridge 25/03/08

361 The Ridge 08/08/06

Similar services:

Thorndene

Insight - Eastchurch

Southfields

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

Lyncol House

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 Key Unannounced Inspection 7th March 2007 12:00 361 The Ridge DS0000065396.V325953.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.V325953.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.V325953.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 Limited Vacant Care Home 10 Category(ies) of Learning disability (10) registration, with number of places 361 The Ridge DS0000065396.V325953.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. That the home is registered to accommodate up to ten (10) service users That the service users are aged 25 years and over upon their admission That the category of service users admitted have a learning disability, not falling within any other category That the service users may present with associated physical needs, including age-related conditions 8th August 2006 Date of last inspection Brief Description of the Service: 361 The Ridge is a care home, which provides personal care and accommodation for up to 10 residents 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 that provides care to people specifically with learning disabilities. 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 10 July 2006 range between £1260.43 £1540.43 per person per week. Additional costs are charged for hairdressing, toiletries and external leisure activities (£ variable). Prospective residents and their relatives are provided with written information regarding the services and facilities provided at the home prior to admission. 361 The Ridge DS0000065396.V325953.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. 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’. The CSCI met with two senior representatives of CMG at the Eastbourne Area Office in September 2006 to discuss the serious concerns, which were raised at the home’s last inspection. In response to this a detailed improvement plan was submitted by the organisation. The purpose of this unannounced key inspection was to monitor the home’s progress and compliance with the Regulations that underpin the National Minimum Standards. This unannounced inspection took place on Wednesday 7th March 2007 and was undertaken by two Inspectors. The inspection lasted approximately five hours. Nine residents were accommodated on the day of the inspection, four men and five women aged between 38 and 75 years of age. One resident was in hospital on the day of inspection. Individual discussions took place with a number of residents over the course of the inspection. In order to gather evidence on how the home is performing, individual discussions took place with three members of staff on duty in addition to the acting Manager and Regional Operations Manager. Four care records were examined in some detail for the purpose of monitoring care. Other records and documentation inspected included: the home’s assessment and care planning procedures, medication practices, the provision of activities, complaints procedure and the systems in place to safeguard residents from harm, staffing levels and the provision of relevant training. In addition, the home’s systems for monitoring their own effectiveness and managing residents’ personal finances were inspected. All areas of the home were seen. A pre-inspection questionnaire was received prior to the visit to the home. This provided the Inspector with information relating to the premises, maintenance and associated records and details of the home’s policies and procedures. 10 residents’ survey questionnaires were sent to the home prior to the inspection, nine of which were returned. All of these had been completed either with support from care staff or on individual’s behalf. Some of the comments received have been included within this report. What the service does well: 361 The Ridge DS0000065396.V325953.R01.S.doc Version 5.2 Page 6 361 The Ridge is a newly refurbished home that presents as well-maintained, clean and a homely throughout. Rooms were seen to be furnished to a high standard and are personalised to reflect the personality of the individual. Some residents have their own TV’s/DVD players and stereos in place, whilst one person has their own telephone line installed and Digital TV reception (at an additional cost to that person). Residents confirmed that they are generally happy with the overall provision of care. Their comments include: “I know this is the right place for me” “I get all the things I need” “I go shopping with my key worker as much as possible and I enjoy knitting and colouring” The attitude of care staff helps to promote residents’ choice and autonomy. What has improved since the last inspection? The home has worked hard to meet many of the requirements made at the last inspection. In order to address the incompatibility of some of the residents who were accommodated at the home’s last inspection, all residents have been reassessed by CMG and their Care Managers. Consequently Care Managers for three residents are in the process of finding more suitable alternative accommodation. Once such placements are identified, the existing group of residents will be better supported by care staff and by their peer group within the home. Much work has been undertaken by the home to implement plans of care for each person based on risk assessments. Some guidance is now in place in order to support care staff in meeting individuals’ health and personal care needs. Care staff have taken the time to explore residents’ leisure interests and support residents to maintain contact with friends and family. Improved support for residents during mealtimes is now in place. This ensures that mealtimes are now a more pleasurable and relaxed experience for residents. The home has reviewed and implemented clearer policies and procedures for the safe handling of medicines. 361 The Ridge DS0000065396.V325953.R01.S.doc Version 5.2 Page 7 The home’s improved recruitment procedures, specialist training for staff in relation to meeting residents’ healthcare needs and adult protection training helps to ensure that residents are better protected from harm, neglect or abuse. 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. 361 The Ridge DS0000065396.V325953.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.V325953.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): 2 and 5. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The compatibility of residents living within the home will be improved once alternative placements have been identified for a small number of people. Residents are provided with a statement of their terms and conditions of contract. EVIDENCE: Following concerns, which were raised at the home’s last inspection in relation to the compatibility of the residents living at the home due to the home’s poor pre-admission assessment procedures, CMG’s Director of Clinical Care undertook an assessment of each person in order to determine whether or not the home is suited to meet their needs. Each assessment was undertaken in conjunction with care staff and individuals’ Care Managers. The Inspector received a detailed report in relation to this prior to the inspection. As a result of this assessment, it was determined that Care Managers for three residents will begin to seek alternative and more appropriate placements. It is anticipated that this will take no longer than three months. Albeit that there have been no new admissions to the home since the last inspection, a requirement remains for the home to ensure that no person is admitted to home whose needs have not been thoroughly assessed by a person trained to 361 The Ridge DS0000065396.V325953.R01.S.doc Version 5.2 Page 10 do so. Final decisions regarding all new admissions to the home must be taken in conjunction with the home’s Manager with a clear understanding of what the home is able to provide. The best interests of the established resident group must be taken into account. Throughout the duration of the inspection, observations made and through discussions with care staff and residents, concerns were raised regarding the placement of one particular person who the home considers to be suitably placed. They were observed to upset some residents by continually pacing around the home and frequently shouting – often at other residents. This impacted on the activities that were taking place, conversations and interactions between staff and residents. Staff commented that this is a daily occurrence, which ‘gets very wearing for everyone’. This has been raised directly with the Regional Operations Manager and the Director of Clinical Care. CMG have assured the CSCI that this placement will be closely monitored. Whilst the home’s Statement of Purpose was not assessed on this occasion, in light of the concerns that have been raised in relation to the compatibility of residents and comments received from Care Managers who felt that the home’s literature is misleading, it would appear that the home have been trying to meet too broader range of needs. The home will need to review and amend the Statement of Purpose and Service Users’ Guide in order to determine and define the range of needs that the care home is intended to meet. It was pleasing to note that one resident who returned a survey questionnaire to the CSCI prior to the inspection stated: “I know this is the right place for me” Completed copies of residents’ terms and conditions of contract were seen in individual care records. These provide the person and their representatives with information regarding what residents can expect for the fee they pay and sets out the terms and conditions of occupancy. This is improved since the last inspection. 361 The Ridge DS0000065396.V325953.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, 8 and 9. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care planning procedures are improved, although residents would benefit from a person centred approach in order to promote their individual needs, decisions and choices. EVIDENCE: All residents have a template care plan in place, which has been produced by CMG. The main areas within these include: a pen portrait of the person, their health, how they manage their emotions, how they communicate, their cultural beliefs, their relationships with others and activities of daily living. Whilst all areas of daily living are based on individual risk assessments, it was noted that the current care planning format is not person centred for each individual, or easy for staff to read, understand and follow. This is possibly due to the fact that there is too much information included (some of which is irrelevant). For example: 361 The Ridge DS0000065396.V325953.R01.S.doc Version 5.2 Page 12 - In one person’s care plan, 23 risk assessments had been undertaken for the person to be supported with eating and drinking. Yet there was no clear guidance for staff to follow in order to enable them to support that person at mealtimes. - In another persons care plan four pages of written information had been recorded regarding their epilepsy. On closer inspection, it became apparent that they were irrelevant to that person and failed to provide care staff with clear guidance about what they should do in order to support that person in the event of them having a seizure. - Each of the care plans state that individuals need to be supported to take part in activities to promote their independence, yet there were no preferred activities documented based on the needs and preferences of each person. - A number of risk assessments had been undertaken for some activities of daily living that the person was not interested to do e.g. washing up, tidying their bedroom and using a kettle. Detailed discussions took place with the acting Manager and Regional Operations Manager on the day of inspection regarding this. Not withstanding that significant improvements have been noted in respect of the home’s care planning procedures, the home is required to ensure that all plans of care are person centred based on the individual needs and preferences of each individual. Feedback from residents regarding how they are supported to make decisions each day were variable, although it is recognised that due to the cognitive abilities of some this may often be difficult for care staff to facilitate. Comments received from residents include: “I would like carers to ask me what I would like to do for the day…I would like to go out and about more often at weekends” “I get all the things I need” Detailed discussions took place with staff regarding how they support residents to make choices and decisions about their lives and participate in the day-today lifestyle of the home. It was pleasing to note that staff had a good understanding of individuals’ subtle level of non-verbal communication and were conscious of their approach towards this. One member of staff said: ‘It is the way in which you offer choices and your approach towards [the person] that makes the difference’. An appointed advocate has been consulted for one resident since the last inspection. 361 The Ridge DS0000065396.V325953.R01.S.doc Version 5.2 Page 13 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. This judgement has been made using available evidence including a visit to this service. Residents are supported to take part in a range of activities and to maintain positive relationships with family and friends. The provision of food is good. EVIDENCE: Concerns were raised at the home’s last inspection regarding the provision of activities. On the Inspectors’ arrival, no residents were engaged in activities, however within a relatively short period of time, one person was sat at the dining table with a member of staff engaging in a one-to-one activity, whilst three other residents were playing bingo. Feedback from residents and staff on the day of the inspection indicated that the overall provision of activities within the home is improved. “I go shopping with my key worker as much as possible and I enjoy knitting and colouring” 361 The Ridge DS0000065396.V325953.R01.S.doc Version 5.2 Page 14 “I especially like to watch the TV” In-house activities include: playing pool and other games, motivation sessions, music, art, aromatherapy, African drumming and gardening (when the weather permits). Residents confirmed that they do access community facilities regularly such as cafes, shopping centres, pubs and leisure facilities. Staff commented that this is improved due to increased staffing levels. The home has a notice board in the main living area, which was found to contain a map of the local area and an advert for a forthcoming show. Residents spoken with told the Inspectors about some of their favourite pastimes and leisure interests, however as already mentioned not all of these had not been documented within individual plans of care. Only one person at this time has any structured day service provision in place, although the acting Manager reported that the home is currently looking into this option for another person. This will be followed up at the next inspection. One resident spoken with said that they are in regular contact with a friend who lives elsewhere and that care staff were supporting her to visit her friend the following day. This is improved since the last inspection. During an inspection of the premises all staff were observed to knock on residents’ bedroom doors prior to entering. All doors are fitted with locks and residents may request a key as they wish, however no residents at this time have chosen to have one. All residents are addressed by their preferred term. All meals are prepared within the home by care staff who have obtained a certificate in Food Hygiene. A recommendation was made at the last inspection for the home to work with residents, as part of an activity to devise colourful pictorial menus for the week. Whilst the Manager said that this had been undertaken, it was noted on the day of inspection that none of the residents were aware of what they were having for lunch, as the pictures had not been displayed. This indicates that despite this activity taking place, the home are not using the pictures for the benefit of residents. In addition, it was noted that care staff were preparing the lunchtime food (sandwiches) without any assistance from residents. A recommendation has been made in respect of this. Some of the residents require additional support at mealtimes. Residents were observed to be offered discreet support over the lunchtime period in a quiet and relaxing atmosphere. It was pleasing to note that individual guidelines are now in place for each person. This is improved since the last inspection. 361 The Ridge DS0000065396.V325953.R01.S.doc Version 5.2 Page 15 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. Care staff have received specialist healthcare training. This better equips them to meet the assessed needs of residents. Medication procedures are improved. EVIDENCE: Following some serious concerns, which were raised at the home’s last inspection regarding home’s ability to meet the needs of residents with additional healthcare needs, it was pleasing to note that all staff have undertaken the appropriate specialist training in order to better equip them to meet residents’ needs (for new members of staff forthcoming training dates are in place). This training includes: epilepsy training, pressure area care, continence and diabetes. Individual guidelines are now in place within plans of care, however as already mentioned, these are not particularly easy for staff to read, understand and follow. One concern was raised on the day of inspection, which resulted in an immediate requirement being issued. It was noted that care staff have been monitoring one person’s blood sugar levels whilst they are sleeping. It was 361 The Ridge DS0000065396.V325953.R01.S.doc Version 5.2 Page 16 reinforced to the Manager and Regional Operations Manager that this practice is without the resident’s consent, invasive and therefore unlawful. 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. Senior members of staff are responsible for the reordering and returning of medicines to the pharmacy. Following advice from a CSCI Pharmacy Inspector shortly after the home’s last inspection, significant improvements have been implemented by the home in relation the home’s policies and procedures for the safe handling of medicines. The home’s medication cupboard has been moved to a larger and more secure area of the home. Photographs have been added to the medication administration records and residents’ profiles have been updated. In addition, social leave arrangements are in place, which all staff demonstrated they were familiar with on the day of inspection. Clear procedures are now in place for all medication that is received by the home and those, which are returned to the pharmacy. The home is required to ensure that all medicines that are refused by residents or not administered for any reason are clearly labelled in line with the home’s policies and procedures. This must include the name of the resident, medicine, reason for non-administration and the date on which it should have been administered. 361 The Ridge DS0000065396.V325953.R01.S.doc Version 5.2 Page 17 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. This judgement has been made using available evidence including a visit to this service. The home has improved systems in place to ensure that complaints are dealt with appropriately and to ensure that residents are protected from 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), which clearly explains how complaints can be made, who they can be made to, how residents can expect their complaint to be dealt with and the timescale within which it will be responded to. The majority of the returned residents’ questionnaires confirmed that most residents would feel happy to raise any concerns directly with the home or with the support of a relative. Whilst feedback was not received from relatives during this inspection, CMG have assured the CSCI that all relatives have been provided with a copy of the complaints procedure since the last inspection. A number of concerns were raised to Social Services in December 2006, which resulted in a series of Adult Protection Strategy Meetings and investigations led by Social Services. Care Managers and the CSCI were also involved. The outcome of these investigations were concluded in March 2007. Whilst not all areas were substantiated, a small number of areas were. These are being addressed by Care Managers and will be closely monitored by the CSCI. Staff confirmed on the day of inspection that they have received specific adult protection training since the last inspection. Refresher dates are booked. 361 The Ridge DS0000065396.V325953.R01.S.doc Version 5.2 Page 18 The acting Manager acts as the appointee for eight residents. The home holds residents’ personal allowances at the home, which all care staff have access. A sample of these were randomly checked and found to be in order. 361 The Ridge DS0000065396.V325953.R01.S.doc Version 5.2 Page 19 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, 25, 26, 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 a clean, well-maintained and homely place to live. EVIDENCE: One of the Inspectors viewed all areas of the home on the day of inspection. 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. It is anticipated that one of the bathrooms will in due course be converted into a shower room. All hot water outlets have thermostatic valves fitted to ensure hot water temperatures do not exceed the recommended 43°C. 361 The Ridge DS0000065396.V325953.R01.S.doc Version 5.2 Page 20 There is a large lounge/dining area for residents to share, which is pleasantly decorated and furnished and a sensory room for residents to use. Residents’ bedrooms were found to be nicely decorated and contain photographs, personal pictures and furnishings. Some residents have their own TV’s/DVD players and stereos in place, whilst one person has their own telephone line installed and Digital TV reception (at an additional cost to that person). Care staff informed the Inspector that they are responsible for undertaking all cleaning duties including laundry, although some residents are encouraged to maintain their own bedrooms where possible. Whilst most areas of the home were noted to be clean, tidy and well-maintained, some carpets throughout the home are in need of cleaning and/or replacing. There is large room on the top floor, which is currently used for staff training or for visiting relatives as, it has a small kitchen area and en-suite facilities. The Inspectors did note that this use of space could be better utilised for residents to use for activities. A recommendation has been made in respect of this. 361 The Ridge DS0000065396.V325953.R01.S.doc Version 5.2 Page 21 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. This judgement has been made using available evidence including a visit to this service. Residents are supported by a knowledgeable, well-trained and supervised staff team. Recruitment procedures are improved. EVIDENCE: In addition to the acting Manager, 361 The Ridge employs a total of 10 Support Workers, two senior staff and a Deputy Manager, although the latter is currently working at another CMG home for a period of three months. Of the 13 care staff, seven have achieved at least NVQ Level 2 in Care, whilst 10 hold a current First Aid certificate. Most of the staff spoken with confirmed that a good level of training is offered by CMG and that individual training needs are identified through staff supervision. This is improved since the last inspection. Six staff have left the home since the last inspection. Although most of these posts have recently been filled, the home has been reliant upon agency staff, particularly throughout December 2006. The Manager, staff and rotas confirmed that this is now improved. 361 The Ridge DS0000065396.V325953.R01.S.doc Version 5.2 Page 22 Four recently appointed staff members’ recruitment files were examined. Shortfalls were identified at the home’s last inspection. It was pleasing to note that since this time, the Manager has worked hard to ensure that all the correct documentation and checks are in place for all existing and newly appointed staff including two written references, Criminal Record Bureau (CRB) and Protection of Vulnerable Adults (PoVA) First checks. All checks were available for inspection. CMG implemented a new induction package for all new employees in November 2006 based on Skills for Care. All new staff spoken with said that they had received a thorough induction to the home within their first six weeks of appointment including a two week ‘shadowing’ period with a senior member of staff. 361 The Ridge DS0000065396.V325953.R01.S.doc Version 5.2 Page 23 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 overall conduct and management of the home is improved, however the home’s quality assurance systems need to be developed to maintain a high quality of care for the residents accommodated. The health and safety of residents and staff is protected. EVIDENCE: The home has been without a Registered Manager since the home first registered with the CSCI in November 2005. The acting Manager withdrew her application to become the Registered Manager of the home in February 2007. She is due to leave her employment in April 2007. The Regional Operations Manager confirmed on the day of inspection that CMG are currently in the process of recruiting to this post. It remains an outstanding requirement for an application to be submitted to the CSCI for a suitably 361 The Ridge DS0000065396.V325953.R01.S.doc Version 5.2 Page 24 qualified, competent and experienced person to become the Registered Manager of the home. The acting Manager is supervised by a Regional Operations Manager. She visits the home on a monthly basis to interview staff and talk with residents in order to gain their feedback about the service, inspect the premises and a number of the home’s records. Detailed reports are written regarding the outcome of these visits, which are forwarded to the CSCI in accordance with Regulation 26. Whilst there was evidence to suggest that some questionnaires have been sent out to residents, staff and other stakeholders, further work is required in this area. Following concerns, which were raised at the home’s last inspection relating to a number of the home’s policies and procedures, CMG and staff spoken with confirmed that a number of these have been reviewed and revised where necessary (particularly in relation to meeting healthcare needs). Staff also commented that further training on key policies and procedures is undertaken during supervision sessions and staff meetings. A staff handbook is being developed. Evidence provided within the home’s returned inspection questionnaire identified that all equipment is well-maintained and regularly serviced including: fire equipment, electrical appliances, gas installation, emergency lighting and adaptations and equipment. 361 The Ridge DS0000065396.V325953.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for 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 2 2 2 3 X 4 X 5 3 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 3 26 3 27 3 28 3 29 X 30 2 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 2 3 3 2 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 2 2 2 X 2 X 2 X X 3 X 361 The Ridge DS0000065396.V325953.R01.S.doc Version 5.2 Page 26 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. Standard 1 YA1 Regulation 4(1)(2)(3) 5(1)(2)(3) Sch 1 Requirement Timescale for action 30/09/07 2. YA2 12(1)(a-b) 14(1)(a-d) 14(2)(a-b) 3. YA6 YA9 YA19 15(1)(2)(a-d) 13(4)(a-c) 12(1)(a-b) That the home’s Statement of Purpose and Service Users’ Guide is reviewed and amended in order to determine and define the range of needs that the care home is intended to meet. Copies of these must be forwarded to the CSCI. 30/09/07 That no person is admitted to the home whose needs have not been thoroughly assessed by a person trained to do so. Final decisions regarding admissions to the home must be taken in conjunction with the home’s Manager with a clear understanding of what the home is able to provide. The best interests of the established resident group must be taken into account. That all plans of care are person 30/09/07 centred based on the individual needs and preferences of each individual. These must be based on individual risk assessments and written in an easy to read, understand and follow format for care staff. Clear guidance regarding all DS0000065396.V325953.R01.S.doc Version 5.2 Page 27 361 The Ridge 4. YA18 YA19 12(1)(2)(3) (4) 5. YA20 13(2) 17(1)(a) Schedule 3(i)(k) 6. 7. YA30 YA37 23(2)(d) 18(1)(a) 8. YA39 24(1)(a)(b) 24(3) individual healthcare needs must be in place. That monitoring blood sugar levels for people with diabetes is only undertaken with the consent of the individual. Care plans must be updated accordingly. [Immediate requirement]. That all medicines that are refused by residents or not administered for any reason are clearly labelled in line with the home’s policies and procedures. This must include the name of the resident, medicine, reason for non-administration and the date on which it should have been administered. That all carpets throughout the home are kept clean and/or replaced. That an application is submitted to the CSCI for a suitably qualified, competent and experienced person to become the Registered Manager of the home [Outstanding from 30/09/06]. That effective quality assurance systems are implemented in order to seek feedback from others including residents, regarding how the home is performing [Outstanding from 30/09/06]. 07/03/07 07/03/07 30/09/07 30/09/07 30/09/07 361 The Ridge DS0000065396.V325953.R01.S.doc Version 5.2 Page 28 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. 2. 3. Refer to Standard YA8 YA17 YA17 YA28 Good Practice Recommendations That the home considers different ways in which residents can become involved in participating in all aspects of life in the home e.g. meal preparation. That the pictorial menus are displayed on a daily basis to inform and offer a greater choice to residents. That consideration be given to utilising the large training room/visitors room on the top floor for residents to use for activities. 361 The Ridge DS0000065396.V325953.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone Kent..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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