Inspection on 08/08/06 for 361 The Ridge

This inspection was carried out on 8th August 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 no outstanding requirements from the previous inspection report, but made 29 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 07/03/07

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 Unannounced Inspection 08 August 2006 09:50 361 The Ridge DS0000065396.V301383.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.V301383.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.V301383.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.V301383.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 This is the home’s first inspection. 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. 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.V301383.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’. This unannounced inspection took place on Tuesday 08 August 2006 and lasted approximately six hours. 10 residents were accommodated on the day of the inspection, six female and four male aged between 38 and 76 years of age. In order to gather evidence on how the home is performing, individual discussions took place with three residents, whilst others commented on their care during the lunchtime period, the Inspector having been invited to join them for a meal. In addition in depth discussions took place with the acting Manager, four members of care staff and a visiting Social Worker. Six care records were examined in some detail for the purpose of monitoring care. Other records and documentation inspected included: the home’s Statement of Purpose and Service Users’ Guide, medication practices, the provision of activities, quality assurance systems, complaints procedure and the systems in place to safeguard residents from harm, staffing levels and the provision of relevant training. All communal areas and individual rooms were seen. A detailed 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, details of the homes policies and procedures, staffing details and relevant training. 10 residents’ survey questionnaires were sent to the home prior to the inspection, seven of which were returned. Most had been completed with the help from a Support Worker. In addition, written feedback was received by six relatives. As part of the inspection process additional feedback was also sought from members of the Community Learning Disability Team (CLDT) and other health and Social Care professionals. Their views are reflected throughout this report. 361 The Ridge DS0000065396.V301383.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: A number of serious concerns were identified during this inspection. The home has been without a Registered Manager in post since the home first opened in November 2005. The acting Manager has had minimal involvement in the pre-admission assessment process and subsequently residents have been admitted outside of the home’s conditions of registration, which have had a detrimental effect on others already living in the home. Care plans are poor, fail to identify residents’ personal healthcare needs and fail to provide care staff with specific guidance in relation to meeting needs. Staff have received no specialist training to support them in this area and consequently these needs are being unmet. Following the inspection a referral was made to a CSCI Pharmacist Inspector who visited the home on 23 August 2006. The home is required to ensure that medication procedures are safe and adhered to at all times. The provision of activities is limited both within and outside of the home. As a result some residents have minimal interactions with others including staff. 361 The Ridge DS0000065396.V301383.R01.S.doc Version 5.2 Page 7 Care staff are unaware of the home’s policies and procedures, particularly in relation to the Protection of Vulnerable Adults. In light of this and the home’s poor recruitment procedures, residents are being placed at risk. The Commission for Social Care Inspection will be meeting with the Responsible Individual of Care Management Group to express their concerns and to ensure that appropriate action is taken within an agreed timescale to address these issues. 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. 361 The Ridge DS0000065396.V301383.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.V301383.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 and 5. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Whilst sufficient information is provided to prospective residents and their relatives in order to support their decision of where to live, the home’s preadmission assessment procedures fail to identify and plan for specific care needs including taking in to account the needs and compatibility of others living in the home. EVIDENCE: The home has a detailed Statement of Purpose and Service Users’ Guide in place, both of which were seen on the day of the inspection. The Statement of Purpose provides the reader with an introduction to CMG including the home’s aims and objectives, details of the Registered Provider and Manager and the organisational and staffing structure. The Service Users’ Guide offers a good level of information regarding the services and facilities provided, resident specification, room sizes, the provision of staff, residents’ charter, complaints procedure, contact details of the Commission for Social Care Inspection (CSCI), a copy of a resident’s agreement form and the arrangements in place for health and social care support. The Service Users’ Guide is presented in an easy to read and understand format, which incorporates the use of colour pictures and symbols. All of the survey questionnaires that were returned by residents and their relatives confirmed that they feel they received enough 361 The Ridge DS0000065396.V301383.R01.S.doc Version 5.2 Page 10 information prior to admission in order to help them to make a decision about where to live. Concerns have been brought to the attention of the CSCI with regards to the home’s pre-admission assessment procedures since the home first opened in November 2005. CMG employs a team of centrally based Assessment Referral Officers, who are responsible for considering and assessing all initial referrals for each of the homes. The acting Manager commented that she has had minimal involvement or say in a final decision as to whether or not the home can meet the assessed needs of prospective residents. A requirement has been made in respect of this. Six individual pre-admission assessments were requested on the day of the inspection, however only three had been completed. Albeit that some key information had been recorded, not all areas particularly regarding how the home intends to meet specific healthcare needs had been identified. Throughout the duration of the inspection through direct observation, discussions with staff and the examination of care records, concerns were raised in respect of the compatibility of the residents accommodated. It was noted that two residents have been admitted to the home without a learning disability who are reasonably able and mobile, whilst other persons living within the home are heavily reliant on two care staff at all times to support them with their care needs. Staff commented that the inappropriate placement of some residents is at times, detrimental to the needs of others. The home is required to carry out an assessment of each of the residents alongside health and Social Care professionals in order to identify whether or not the home can meet their needs in accordance with the homes conditions of registration. Three of the residents spoken with said that they had visited the home informally prior to moving in – usually for a lunchtime or evening meal. They said that this gave them the opportunity to meet with care staff and other residents living at the home. The home has appropriate terms and conditions of contract for residents, copies of which are included within the home’s Service Users’ Guide and individual care plans. It was concerning to note that not one of the care plans inspected contained a completed copy inclusive of the fees payable. A requirement has been made in respect of this. 361 The Ridge DS0000065396.V301383.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8 and 9. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Care planning procedures are inadequate. Residents’ personal and healthcare needs are at risk of not being met due to care plans not being implemented, completed and reflecting actual current practice. EVIDENCE: A number of care staff were spoken with during the inspection regarding meeting the healthcare needs of the residents accommodated. It became apparent that staff were unclear about many aspects, which should clearly be identified in individual plans of care. Six individual plans of care were requested for inspection, however two persons failed to have a care plan in place. Another two were randomly chosen. All six of those seen were insufficiently detailed and noted to be particularly poor in relation to meeting specific healthcare needs including the management of epilepsy, diabetes, pressure area care and the management of continence. Staff confirmed that they are responsible for updating the care plans of the residents that they are assigned to keywork, however they have received minimal training or guidance in this area. There was no evidence to show or demonstrate that they had 361 The Ridge DS0000065396.V301383.R01.S.doc Version 5.2 Page 12 been reviewed, updated and were current to reflect the needs of residents. The home is required to ensure that all individual plans of care are reviewed and updated by a person trained to do so in order to provide care staff with clear details of the action that is to be taken to meet the personal and healthcare needs of residents. Of the seven returned residents’ questionnaires, only one person said that they ‘always’ make decisions about what they do each day, whilst four said they ‘usually’ do, one said ‘sometimes’ and another said ‘never’. Observations made throughout the day identified that the home is routinely run, for example getting residents up and dressed in the morning, supporting them with breakfast, tidying the bedrooms and cleaning the bathrooms before lunch. Although some residents are encouraged to take part in some of these areas, decision making for most residents is limited, however it is recognised that due to their cognitive abilities this may often be difficult to facilitate. It is recommended that the home consider different ways in which residents can be supported to make decisions about their lives and become involved in participating in all aspects of life in the home. Details of this must be recorded within individual plans of care. The acting Manager of the home stated that residents are encouraged to take responsible risks where necessary according to their completed risk assessment, which Senior Support Workers are responsible for. Those seen included: managing behaviour, epilepsy, mobility and for the use of bedrails, however some were noted to be brief in nature and fail to identify how the home came to assess the overall level of risk. A requirement has been made in respect of this. 361 The Ridge DS0000065396.V301383.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home fails to provide residents with a variety of meaningful activities and opportunities. The provision of food is adequately managed. EVIDENCE: All of the care staff and others spoken with commented that daily activities both within and outside of the home are limited. Only one person attends a day service, which is arranged for one day every two weeks. The acting Manager explained that some of the difficulties the home is experiencing in this area include: an increased level of support needs for residents since the home has been fully occupied, reduced numbers of staff on duty due to holidays and a new minibus, which has recently been purchased although only a small number of staff are permitted to drive it. Some residents informed the Inspector that they do enjoy bowling and shopping but this is only organised once a month – dependant upon staffing numbers. On the day of the inspection one member of staff was observed to support one resident with knitting, whilst other residents sat mostly in the lounge area watching a 361 The Ridge DS0000065396.V301383.R01.S.doc Version 5.2 Page 14 Christmas video. Two residents had chosen to remain in their own bedrooms for the day, one of who had minimal contact or interaction with staff. The home is required to review the current arrangements for residents to take part in meaningful daily activities both within and outside of the home. All activities, whether accepted or not by individuals must be recorded within individual plans of care. The Service Users’ Guide states that the home will try, where possible to support residents to maintain friendships and relationships outside of the home. It was therefore disappointing to note that a number of personal profiles within individual plans of care failed to identify ‘People who are important to me’, especially where a resident had been admitted from a nearby care home also owned by CMG. One resident spoken with said that they missed their friends from their previous place of residence and that they would like to maintain contact. A requirement has been made in respect of this. Each of the returned relatives’ questionnaires, residents and conversations with staff confirmed that visitors are always made to feel welcome to the home and there are no restrictions placed on visiting times. A copy of the visiting policy is included within the Service Users’ Guide. All visitors are requested to sign in to the home on arrival in a book located at the main entrance of the building. On the day of inspection, one person’s parents had come to visit from afar; the home had arranged for them to stay in the care home in a selfcontained bedroom located on the second floor, which had previously been used by staff. 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. The daily routines and ‘house rules’ are included within the Services Users’ Guide. All meals are prepared within the home by care staff who have obtained a certificate in Food Hygiene. The Inspector was informed that residents are encouraged to plan the menus one week in advance, with support from care staff. At present, the menu is not displayed. Whilst it is appreciated that very few of the residents would be able to read and understand a written menu, it is recommended that the home works with residents, as part of an activity to devise colourful pictorial menus for the week. Many of the residents have developed difficulties with swallowing (due to age related conditions) and are therefore dependent on staff to ensure that all foods are appropriate to their needs, the right consistency and that the right support is offered at mealtimes. Albeit that staff spoken with were aware of individual guidelines produced by a Speech and Language Therapist, it is recommended that all food including liquidised meals are presented in a 361 The Ridge DS0000065396.V301383.R01.S.doc Version 5.2 Page 15 manner which is attractive and appealing in terms of texture, flavour and appearance. The Inspector joined the residents for lunch on the day of inspection. Whilst the food offered appeared wholesome and nutritious and discreet support was offered to those who needed it, the lunchtime period appeared rather busy and quite chaotic. The television was on in the background and some residents were wandering around. One particular person was observed only to eat two mouthfuls of food before returning to their room – a person with dietcontrolled diabetes. A requirement has been made for the home to consider ways in which all residents can be supported each mealtime, for example with members of staff to sit with them at the table and offer discreet encouragement. 361 The Ridge DS0000065396.V301383.R01.S.doc Version 5.2 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. This home fails to identify and meet the personal and healthcare needs of residents. Medication practices are poor. EVIDENCE: All residents are registered with a local GP and dentist and are supported to appointments as necessary. Specialist advice from the CLDT is requested on an individual basis. Concerns were brought to the attention of the CSCI prior to the inspection, regarding the home’s ability to meet the needs of residents with additional healthcare needs. In order to explore these issues further, individual discussions took place with the acting Manager and care staff on duty, whilst some individual care plans were closely examined. A number of concerns were raised: Two of the residents have epilepsy, however there were no clear management guidelines in place for staff to follow in the event of a seizure occurring. It also emerged through discussions with care staff that they were unaware of the different types of seizures that individual’s have. The home is required to 361 The Ridge DS0000065396.V301383.R01.S.doc Version 5.2 Page 17 ensure that such records are in place to include a brief history of the person’s seizures, a description of what form the seizure takes and instructions for staff to follow in the event of a seizure occurring. Additional training must be provided to all staff. Two of the residents accommodated have developed pressure area care damage to their skin due to reduced mobility. Although specialist equipment is in place to help reduce the risks of tissue breakdown, there is no record of this or guidance in place within individual care plans for staff to follow e.g. what the level of risk is, where the affected areas are, how often residents’ position needs to be changed, what the programme of care is or any records to indicate that any of the above needs are being met. A requirement has been made in respect of this. Three of the residents accommodated have diabetes, which is either controlled by diet or managed with medication, yet their care plans failed to provide staff with any guidance or instructions to follow e.g. how often they are required to monitor blood sugar levels, what staff should do in the event of an abnormal blood sugar reading, or what suitable food alternatives should be offered. Care staff spoken with said that they had not received any training in this area to support them to meet individuals’ needs. A requirement has been made in respect of this. The Inspector was informed by care staff that one resident requires additional support with managing continence. Albeit that a specialist nurse is currently involved, their care plan failed to provide staff with adequate guidance or clear instructions in order to ensure that the individual’s needs are being met. It is required that specialist advice and training is sought from a continence advisor/stoma care nurse and implemented from an up to date comprehensive individual plan of care. 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. Whilst medication records were mostly maintained, it was noted that some prescribed medications had not been given for a number of days as they were out of stock, yet no action was taken by care staff to make appropriate provisions. This shows poor practice in relation to the home’s procedures for ordering and disposing of medicines. A number of tablets were found to have been either left or removed from the blister pack on random days, with no explanation recorded on the medication administration records. Concerns were also raised during observation of two members of staff administering 361 The Ridge DS0000065396.V301383.R01.S.doc Version 5.2 Page 18 medicines after the lunchtime period, which raised concerns in respect of the home’s policies and procedures for the safe administration of medicines. Following the inspection a CSCI Pharmacist Inspector visited and noted that the home had already implemented a number of good practice issues in relation to the above. A senior member of staff has now taken on the responsibility of ordering and receipts of medicines to ensure supplies are received and correct before the start date. Incidentally not all receipts were recorded which would make an audit impossible. A new procedure for administration has been implemented to ensure only trained members of staff are involved in medicine administration. Further update on medicine training from the Organisation’s trainer has been arranged. The Pharmacist noted some additional matters of concern. The medicines security from outside the building potentially presents a risk. Some photos on the medicines administration sheets were not available for identification purposes. A medication errors record book is not available and Management of social leave medication procedure needs to be set up. These matters were discussed with the manager. 361 The Ridge DS0000065396.V301383.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Albeit that systems are in place to support residents in raising any concerns, the home fails to ensure that residents are protected from harm, neglect or abuse. EVIDENCE: The Service Users’ Guide contains an easy to read and understand (including colour pictorial symbols) complaints policy and procedure for residents. It clearly explains how complaints can be made, who complaints can be made to (keyworkers, the Manager, the Regional Operations Manager or the CSCI), how residents can expect their complaint to be dealt with and the timescale within which it will be responded to. All of the returned residents’ questionnaires confirmed that each of the residents would feel happy to raise any concerns directly with the home or with the support of a relative. Five out of the six returned relatives’ questionnaires however, identified that they are unaware of the home’s complaints procedure. The home is required to ensure that all relatives are made aware of and are provided with a copy of the home’s complaints procedure for visitors. Albeit that the home has suitable Adult Protection and whistle-blowing policies and procedures in place and care staff were able to discuss the different types of abuse, they were unable to state who the lead agency is and the action that they would take in the event of suspecting abuse, harm or neglect. In light of this and the home’s poor recruitment procedures, inadequate identification of healthcare needs and insufficient training for staff, the CSCI considers that this home fails to ensure that the health and welfare of residents is protected. The 361 The Ridge DS0000065396.V301383.R01.S.doc Version 5.2 Page 20 home is required to ensure that Adult Protection training including the Protection of Vulnerable Adults (PoVA) is provided to all staff. 361 The Ridge DS0000065396.V301383.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 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: 361 The Ridge is a large former bed and hotel establishment, which was fully refurbished in the summer of 2005. It has been adapted where necessary to accommodate wheelchair users throughout, including a shaft lift to the second floor. The Inspector was shown around all areas of the home by the acting Manager on the day of the inspection. Accommodation is provided over two floors comprising of 10 single rooms all with en-suite facilities, four of which 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 361 The Ridge DS0000065396.V301383.R01.S.doc Version 5.2 Page 22 hot water outlets have thermostatic valves fitted to ensure hot water temperatures do not exceed the recommended 43°C. 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, although in some instances not particularly reflective of residents’ personalities and individual preferences, whilst other rooms contained photographs, personal pictures and furnishings. The acting did explain that some of the residents had very few personal belongings with them on admission. Care staff informed the Inspector that they are responsible for undertaking the majority of cleaning duties including laundry, although some residents are encouraged to maintain their own bedrooms where possible. All areas were noted to be clean, tidy and well-maintained. Any minor repairs are recorded within a maintenance book, which staff confirmed are usually promptly dealt with by a maintenance person. 361 The Ridge DS0000065396.V301383.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home’s poor recruitment procedures, inadequate induction processes and lack of specialist training for staff, fails to ensure that residents are well supported and their needs are met. EVIDENCE: In addition to the acting Manager, 361 The Ridge employs a total of 13 Support Workers, two Senior staff and a Deputy Manager. Of these, six have achieved at least NVQ Level 2 in Care, whilst others are hoping to commence this shortly. 11 hold a current first aid certificate. Most of the staff confirmed that a good level of in-house training is offered by CMG, however as already mentioned further training in relation to meeting personal healthcare needs is required. Staff working hours are divided into shift patterns: 07:30am –15:00pm and 14:30pm – 22:00pm. Two waking night staff are always on duty. The home tries as much as possible to have four staff on each shift in addition to the acting Manager, however many of the staff spoken with, including the acting Manager commented that since the home has been fully occupied with 10 residents, there has been the need to increase staffing levels, however due to staff holidays over the summer period this has been difficult to sustain. 361 The Ridge DS0000065396.V301383.R01.S.doc Version 5.2 Page 24 Consequently the home has been reliant on agency staff and Support Workers covering additional shifts. The acting Manager confirmed that staff vacancies are usually advertised internally throughout the organisation, in local newspapers and/or job centres. Four recently appointed staff members’ recruitment files were examined. Whilst complete application forms and job descriptions were seen, not all persons were in receipt of photograph identification, two written references, a PoVA First or Criminal Record Bureau (CRB) check. The Manager explained that all police checks are organised by CMG’s head office and that all documentation is stored there. The home is required to ensure that two written references are obtained prior to any new member of staff being employed, one of which must be from their previous employer. Photographic evidence must be obtained and there must be evidence of a CRB and PoVA First check. All the necessary recruitment records must be available for inspection. The home’s policies and procedures state that all staff are expected to undertake a thorough induction to the home within the first six weeks of employment. There was no documentary evidence in place to show that this is happening. Staff spoken with said that although they had been shown around the building and the necessary fire precautions, they had been ‘thrown in at the deep end and expected to get on with it’. The home is required to ensure that all new members of staff receive a structured induction programme within the first six weeks of employment. Records must be maintained. 361 The Ridge DS0000065396.V301383.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 40 and 42. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Although residents express satisfaction with the quality of their lives at 361 The Ridge, there is little evidence that their interests are safeguarded and promoted in respect of the home’s management and administration systems. EVIDENCE: The home has been without a Registered Manager since the home first registered in November 2005. The acting Manager was appointed in February 2006, who requested an application for registration in March 2006. To date this has not been received. It is required that an application is submitted to the CSCI for a suitably qualified, competent and experienced person to be registered as the Manager of the home. All of the residents and staff spoken with commented positively of the way in which the home is managed. It was pleasing to note that they feel the Manager is approachable and supportive, however the issues that have been 361 The Ridge DS0000065396.V301383.R01.S.doc Version 5.2 Page 26 raised during this inspection are a cause for concern, which will be addressed separately from this inspection. Residents’ meetings are held every two weeks at the home, minutes of which are kept. The acting Manager confirmed that CMG have provided each of the homes with a Quality Assurance package in order to support Managers audit the overall provision of care through seeking feedback from residents, their relatives, visitors to the home and staff, however little has been implemented or achieved to date. A requirement has been made in respect of this. A number of the home’s policies and procedures were inspected during the inspection. Not withstanding that the majority were considered adequate, it was of serious concern to note that care staff have limited knowledge or understanding of these, particularly in relation to medication and the Protection of Vulnerable Adults. The home is required to ensure that all policies and procedures are current, made available and known to all staff. 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.V301383.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 1 4 3 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 1 ENVIRONMENT Standard No Score 24 3 25 3 26 X 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 1 33 X 34 1 35 1 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 3 3 2 X LIFESTYLES Standard No Score 11 X 12 1 13 1 14 X 15 2 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 1 1 1 X 1 X 1 1 X 3 X 361 The Ridge DS0000065396.V301383.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? N/A 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 YA2 Regulation 12(1)(a)(b) 14(1)(a)(b)(c)(d) 14(2)(a)(b) 2. YA2 & YA3 12(1)(a)(b) 14(1)(a)(b)(c)(d) 14(2)(a)(b) Requirement Timescale for action 31/08/06 3. YA2 12(1)(a)(b) 14(1) (a)(b)(c)(d) 14(2)(a)(b) 4. YA5 5(1)(b) That no person is admitted to the home whose needs have not been thoroughly assessed by a person trained to do so. 31/08/06 That final decisions, regarding admissions to the home are taken in conjunction with the home’s Manager with a clear understanding of what the home is able to provide and that the best interests of the established resident group are taken into account. That all residents are 30/09/06 reassessed in order to identify whether or not the home can meet their needs in accordance with the home’s conditions of registration. That completed copies of 30/09/06 residents’ terms and conditions of contract are kept within the home. These must be inclusive of the amount and method of fees. Version 5.2 Page 29 361 The Ridge DS0000065396.V301383.R01.S.doc 5. YA6 15(1) 15(2) (a)(b)(c)(d) 6. 7. YA9 YA12 & YA13 13(4) (a)(b)(c) 16(2)(m)(n) 8. YA15 16(2)(m) 9. YA17 12(1)(a)(b) 10. YA18 & YA19 12(1)(a)(b) 15(1) 18(1)(a)(c)(i) That care plans are reviewed and updated by a person trained to do so. They must reflect the current needs of residents and provide care staff with clear details of the action that is to be taken to meet the personal and healthcare needs of residents. That all risk assessments detail how the level of risk has been assessed. That the current arrangements for residents to take part in meaningful daily activities both within and outside of the home are reviewed. All activities, whether accepted or not by individuals must be recorded within individual plans of care. That residents are supported to maintain friendships and relationships outside of the home. That residents who are prone to wandering at mealtimes and who require encouragement to eat a healthy diet are supported to do so by care staff at mealtimes. Care plans must be amended as necessary. That individual epilepsy management guidelines are in place. This must include a brief history of the person’s seizures, a description of what form the seizure takes and clear instructions for staff to follow in the event of a DS0000065396.V301383.R01.S.doc 30/09/06 30/09/06 30/09/06 30/09/06 31/08/06 30/09/06 361 The Ridge Version 5.2 Page 30 11. YA18 & YA19 12(1)(a)(b) 15(1) 12. YA18 & YA19 12(1)(a)(b) 15(1) 18(1)(a)(c)(i) 13. YA18 & YA19 12(1)(a)(b) 15(1) 18(1)(a)(c)(i) 14. YA20 13(2) 17(1)(a) Schedule 3(i)(k) 15. YA20 13(2) 17(1)(a) seizure occurring. Specialist training must be provided to all staff. That sufficient guidance and information for staff to follow is detailed within individual plans of care for all residents who are at risk of pressure area care damage. This must include recording charts. That sufficient guidance and information for staff to follow is detailed within individual plans of care for all residents with diabetes. Specialist training must be provided to all staff. That specialist advice and training is sought from a continence advisor/stoma care nurse and implemented from an up to date comprehensive individual plan of care. That the home’s policies and procedures for the safe administration of medicines are reviewed. Appropriate action must be taken from the advice of the Pharmacist Inspector. That a complete record is kept of all medication received into the home from whatever source. That all relatives are made aware of and are provided with a copy of the home’s complaints procedure for visitors. That Adult Protection and the Protection of Vulnerable Adults (PoVA) training is provided to all staff. 31/08/06 31/08/06 30/09/06 30/09/06 30/09/06 16. YA22 Schedule 3(i)(k) 22(1) 30/09/06 17. YA23 13(6) 30/09/06 361 The Ridge DS0000065396.V301383.R01.S.doc Version 5.2 Page 31 18. YA32 18(1)(a)(c)(i) 19. YA34 19 & Schedule 2 17(3)(a)(b) 20. YA35 18(1)(c)(i) 21. YA37 18(1)(a) 22. YA39 24(1)(a)(b) 24(3) 23. YA40 17 That the training needs of all staff are identified and a clear programme implemented by the organisation. That no person is employed to work at the home without the satisfactory recruitment checks. This must include two written references, photographic identification and the minimum of a PoVA First check. These must be available for inspection. That all new members of staff receive a structured induction programme within the first six weeks of employment. Records must be maintained. That an application is submitted to the CSCI for a suitably qualified, competent and experienced person to become the Registered Manager. That effective quality assurance systems are implemented in order to seek feedback from others including residents, regarding how the home is performing. That all policies and procedures are current, made available and known to all staff. 30/09/06 31/08/06 31/08/06 30/09/06 30/09/06 31/08/06 361 The Ridge DS0000065396.V301383.R01.S.doc Version 5.2 Page 32 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 YA7 & YA8 2. 3. YA17 YA17 Good Practice Recommendations That the home considers different ways in which residents can be supported to make decisions about their lives and become involved in participating in all aspects of life in the home. That the home works with residents, as part of an activity to devise colourful pictorial menus for the week. That all food including liquidised meals are presented in a manner which is attractive and appealing in terms of texture, flavour and appearance. 361 The Ridge DS0000065396.V301383.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection East Sussex Area Office Ivy House 3 Ivy Terrace Eastbourne East Sussex BN21 4QT National Enquiry Line: 0845 015 0120 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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