Inspection on 25/10/06 for Lower Ridge HFE

This inspection was carried out on 25th October 2006.

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 but made no statutory requirements on the home.

Other inspections for this house

Lower Ridge HFE 03/03/06

Lower Ridge HFE 20/09/05

Lower Ridge HFE 09/11/04

Lower Ridge HFE 14/06/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Lower Ridge HFE Belverdere Road Burnley Lancashire BB10 4BQ Lead Inspector Mrs Pat White Unannounced Inspection 25th October 2006 10:15 X10015.doc Version 1.40 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 Lower Ridge HFE DS0000035131.V313859.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 Older People. 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. Lower Ridge HFE DS0000035131.V313859.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lower Ridge HFE Address Belverdere Road Burnley Lancashire BB10 4BQ 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) 01282 429020 01282 429020 Lancashire County Care Services Miss Eunice France Care Home 35 Category(ies) of Dementia (5), Dementia - over 65 years of age registration, with number (5), Mental Disorder, excluding learning of places disability or dementia - over 65 years of age (1), Old age, not falling within any other category (35) Lower Ridge HFE DS0000035131.V313859.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. The registered provider must at all times employ a qualified manager who is registered with the Commission for Social Care Inspection Within the overall registration of 35, a maximum of 35 service users who fall into the category of Older People Within the overall registration of 35, a maximum of 5 service users over the age of 65, who fall in the category of Dementia Elderly Wthin the overall registration of 35, a maximum of 5 service users who fall in the category of Dementia Within the overall registration of 35, a maximum of 1 named service user who falls into the category Mental Disorder (Elderly). When the named service user no longer requires this place, the Registered Provider must notify the Commission for Social Care Inspection 3rd March 2006 Date of last inspection Brief Description of the Service: Lower Ridge is registered with the Commission for Social Care Inspection to provide personal care and accommodation for thirty- five people. The home is owned by Lancashire County Council and managed by Lancashire County Care Services. The property is a three storey building set back off a main road and on a bus route to Burnley. There are gardens to the side and rear. The garden at the rear has been created with decking and raised flowerbeds for the residents to enjoy. Accommodation is offered in single bedrooms and there are a number of lounges. There is a conservatory, a visitor’s room and a treatment room. A passenger lift links the 3 floors. There were sufficient bathrooms and toilets, and various equipment was provided throughout the home to assist residents to be independent. The fees charged are £320 - £360 per week for care and accommodation, with extra charges for hairdressing, chiropody, toiletries and papers and magazines. Lower Ridge HFE DS0000035131.V313859.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was an unannounced “key” inspection, the purpose of which was to determine an overall assessment on the quality of the services provided by the home. This included checking important areas of life in the home that should be checked against the National Minimum Standards for Older People, and checking the progress made on the matters that needed improving from the previous inspection. The inspection took 7 hours 15 minutes. The inspection included: talking to residents, touring the premises, observation of life in the home, looking at residents’ care records and other documents, discussion with members of staff and discussion with the manager, Eunice France. Written information about the home (the pre inspection questionnaire) was provided to the Commission prior to the site visit. Survey questionnaires from the Commission were sent to the home for residents and relatives to complete. However none were returned. Six residents were spoken with in some depth and their views are included in the report. Others were spoken to but were unable to give their views about the home. A relative was also spoken with and some comments are included in the report. What the service does well: Residents were well cared for, and had all the health care they needed. Residents spoke very positively about the care in the home. People said, “we’re very well looked after” and “the staff are kind and patient”. A relative was also very satisfied with the care her mother was receiving. Visitors were made welcome and the staff made themselves available to speak to them. Catering arrangements were good with choices and alternatives offered at every meal. Residents thought the meals were ‘very good’. One resident said that the food was “excellent”. Concerns were taken seriously and relatives used the complaints procedure. Staff training and policies and procedures helped protect residents from abuse. Lower Ridge HFE DS0000035131.V313859.R01.S.doc Version 5.2 Page 6 The home was clean throughout, and decorated, furnished and maintained to a good standard. There were a number of different lounges, including a smoking lounge, and a conservatory, so residents had a good choice of where to sit. Residents enjoyed the enclosed garden area at the back of the home in warm weather. The standard of training, and commitment of the Lancashire County Care Services to training, was good. A high proportion of staff had appropriate training that would help them understand the needs of older people. There was a member of the management team on duty at all times, and staff also benefited having an area manager who visited the home every month. Residents could influence the service provided, and had the opportunity of completing questionnaires every 6 months. A newsletter published at the home kept residents informed of events. The residents’ “spending money” kept in the home was managed safely, and good records were kept of money given to residents and spent on their behalf. Health and safety policies and practices made sure that the home was a safe place for the residents and staff. What has improved since the last inspection? What they could do better: Lower Ridge HFE DS0000035131.V313859.R01.S.doc Version 5.2 Page 7 The way new residents were admitted to the home must be improved. The manager should make sure that people are seen, and that their care needs are fully understood and written down before they are admitted to the home. This will enable a decision to be made as to whether or not the home can meet the person’s needs and enable staff to understand the care required. All residents must have a care plan, and all matters of health and social care, including mental health, should be written in sufficient detail to reflect the wide range of the care needed and the residents’ choices and preferences. When residents are at risk of falling there should be an assessment of risk and a plan to help prevent the falls. Some aspects of medication management must be improved to ensure greater safety of the residents. The faulty hot water supply to one resident’s bedroom, which was an ongoing problem, must be repaired as a matter of urgency. The odour in some bedrooms was unpleasant and this must be eliminated. The way staff were recruited to work in the home must be improved to help ensure that residents are protected from unsuitable staff. Staff must not start work until all the police checks have been obtained and two references received, that are signed and dated and from previous employers. 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. Lower Ridge HFE DS0000035131.V313859.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Lower Ridge HFE DS0000035131.V313859.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 4 & 5. Standard 6 was not applicable Quality in this outcome area is adequate. This judgement has been made using available evidence, including a site visit to this service. The home’s admission procedures, including a comprehensive pre admission assessment of prospective residents’ needs for care and support, were not fully followed for all people. This made it difficult to establish whether or not the home could meet the needs. EVIDENCE: The records of two recently admitted residents, and discussion with the manager, confirmed that comprehensive “in house” assessments of these people’s needs for care and support had not been completed prior to admission. The manager had not met these residents before the date of admission. A relative visited the home the day before the admission and assisted the manager to begin an assessment. This assessment was incomplete and not dated. There were no details on continence, social, hobbies and interests and mental health even though there were needs relating to a diagnosis of dementia. The falls risk assessment was also incomplete. For the other resident whose records were viewed the in house Lower Ridge HFE DS0000035131.V313859.R01.S.doc Version 5.2 Page 10 assessment was completed on the day of admission and the social work assessment was dated a week after the admission. Residents said they were well looked after and that staff carried out their caring duties with kindness and patience. Staff also had the opportunity to undertake training in dementia awareness in order to help them to understand the needs of those residents with dementia. However because the mental health needs of some residents were not being recorded it was unclear whether or not these needs were being met. Lower Ridge HFE DS0000035131.V313859.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a site visit to this service. Residents had care plans that helped staff to provide personal care for residents. However these plans did not have sufficient detail on all matters of health, personal and social care, or on how residents preferred their care to be carried out. Residents’ health care needs were monitored and addressed but some medication procedures and practices could be improved to further safeguard residents’ health. Residents felt staff treated them properly and with respect. EVIDENCE: The viewing of records showed that residents had care plans. However one resident who had lived in the home for about 4 weeks did not yet have a care plan. The existing care plan documentation viewed covered all aspects of health, personal and social care needs and included, life history, personal profile and choices in day to day living and risk assessments. There was evidence that the care plans were being reviewed but not all aspects of the care plan were updated. Lower Ridge HFE DS0000035131.V313859.R01.S.doc Version 5.2 Page 12 The care plans viewed did not contain sufficient detail of what and how care and support should be provided and did not reflect the diversity of the care needs. Some sections of the care plans had not been completed and mental health issues were not addressed even though these were relevent for some residents. For one resident the care plan clearly identified the importance of religion in her life prior to going to live in the home, but did not indicate how this would be maintained in the home. In another care plan viewed the general risk assessment identified a risk of falling but there was no risk assessment to show how this could be managed. Records kept in the home showed that residents had access to the health care they needed. Records and observation showed that pressure area care was promoted in the home. There was a clear link between the identified risk of pressure areas, the preventative measures required and the action taken. District nurses were involved appropriately and supplied equipment and treatment. The use of beds rails was supported by risk assessments involving the District Nurses. However there was also evidence that the use of bedrails for this resident needed to be reviewed. There were policies and procedures covering most aspects of the receipt, recording, storage, handling, administration and disposal of medicines, and including self medication. Policies and procedures were however needed for “when required”(PRN) medication and drug errors. Residents could choose whether or not to manage their own medication and there were lockable facilities in each room for the storage of medication. In general residents’ medication was managed, stored and administered safely in the home and the MAR sheets were completed properly and accurately. These and a spot check of residents’ medication showed that in general residents were given the correct medication at the right times. Areas of good practice include staff checking the prescriptions prior to dispensing and only appropriately trained staff administering medication. However the following matters needed to be rectified in order to ensure the safe management of residents’ medication: • There was no record of the homely remedies taken by one resident or that the GP or pharmacist had sanctioned this. • Two residents were adminstering some of their medication themselves, including a daily insulin injection. These were not recorded on the MAR sheets and there were no supporting risk assessments. • The MAR sheets viewed showed that not all medication received into the home was being recorded. • The criteria for when PRN medications should be given, for example Lactulose, were not fully defined. • The manager had altered the dose of one medication without consultation with the residents’ GP. • Hand written alterations and additions to the instructions on the MARs by the manager were not being witnessed. Lower Ridge HFE DS0000035131.V313859.R01.S.doc Version 5.2 Page 13 • • • • • One resident had the use of an oxygen cylinder in his room - there was signage in place - but the cylinder was free standing and not secured and could potentially injure someone if knocked over. The temperature of the medication storage area was not being monitored. Some creams were not stored securely in people’s rooms . Separate supplies of eye drops for each eye were not obtained. There was evidence of medication being taken out of it’s original container and being administered at a later time. The importance of respecting the residents’ rights to privacy and dignity was recognised in the home and staff were seen speaking to residents respectfully and knocking on bedroom doors before entering. One resident stated that staff respected his dignity when assisting him bathing and allowed him to bath himself with supervision. Residents stated that staff treated them appropriately and were kind and patient. A member of staff spoken with confirmed that the importance of privacy and dignity was covered in the Induction training of new staff. Lower Ridge HFE DS0000035131.V313859.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above 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, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence, including a site visit to this service. There were varied leisure activities which appeared to suit the needs and preferences of the majority of residents. Residents had sufficient choices in their everyday lives and were enabled to maintain contact with their relatives and the community. The food served was wholesome and varied and met the needs and the preferences of the residents. EVIDENCE: Some routines were flexible to suit individual preferences. Residents confirmed that they could go to bed and get up when they wanted and sit wherever they wanted, including the designated smoking lounge. Some preferred routines were recorded on the care plan. Since the previous inspection different leisure activities had been developed. Activities listed on the notice board, and in the Pre Inspection Questionnaire, included music sessions, bingo, entertainers, dominoes, quizzes and gardening in the home’s sensory garden. Some residents spoken with said they enjoyed some of these Lower Ridge HFE DS0000035131.V313859.R01.S.doc Version 5.2 Page 15 activities, but two said there were not many outings. Some residents said they had enjoyed making Christmas cards for the Christmas fayre. Residents religious persuasion was recorded on the assessment, but in the records viewed the care plan did not give indication of how this interest could be maintained and practiced. The three relatives who completed comment cards and the relative who was spoken with said that they were welcome in the home at any reasonable time, that staff communicated all the relevant information to them and consulted with them. The pre inspection questionnaire stated that Church Ministers visited the home. Residents had some choices (see above), and which included choices of meals. Residents could also smoke in the smoking lounge. Most residents had brought small items of furniture from home to personalise their rooms. Residents could bring their own bed from home. Some residents managed their own finances and were assisted by staff to do this. Discussions with residents, and the menus viewed, showed that the food served was wholesome, varied and nutritious. All residents spoken with praised the food. Comments were made, such as the food was good, excellent and I enjoy the food. A cooked breakfast was available every day and a snack meal was served at lunchtime when there was a choice of hot and cold snack dishes, such as soup and sandwiches, and a choice of desserts. The main meal was served in the evening and there was a choice of two cooked dishes. The cook knew people’s likes and dislikes and changed the menus every few weeks according to residents’ preferences. Residents ate in a spacious dining room. Lower Ridge HFE DS0000035131.V313859.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence, including a site visit to this service. The local authority complaints procedure was available to residents and visitors, and residents stated that they knew who to speak to if they had any concerns. There were satisfactory policies and procedures to protect the residents from abuse and residents felt safe living in the home. EVIDENCE: The home had a Local Authority complaints procedure. Two relatives who completed comment cards stated that they were aware of this procedure, one said they were not. One complaint had been made to the Commission in the last 12 months, and had been passed to the home to investigate. This was fully investigated by the area manager according to the homes complaints procedure. Residents spoken with at the time of the inspection stated they had no complaints. Relatives who completed comment cards, and the relative who was spoken with, also stated they had no complaints. The policies and procedures to protect residents from abuse had been viewed at previous inspections and found to be appropriate. There had been no recent allegations or suspicions of abuse and residents’ finances were also protected (see standard 35). Lower Ridge HFE DS0000035131.V313859.R01.S.doc Version 5.2 Page 17 Lower Ridge HFE DS0000035131.V313859.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 23, 24, 25 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a site visit to this service. The home was well maintained and furnished and provided pleasant, comfortable, clean accommodation. Most of the residents’ rooms were comfortable and personalised and suited their needs. However there was a problem with unpleasant odours in some bedrooms and one bedroom had a faulty hot water supply and radiator. EVIDENCE: Lower Ridge is a purpose built residential home near to Burnley town centre. The property is a three storey building set back off a main road and on a bus route to the town centre. There was a passenger lift linking the 3 floors. There were gardens to the side and rear in which residents could walk. There was an enclosed garden at the back of the home with scented plants, decking and raised flowerbeds. It was safe for all residents, including those with dementia, to walk out freely and enjoy this area without staff having to escort Lower Ridge HFE DS0000035131.V313859.R01.S.doc Version 5.2 Page 19 them. There was a choice of communal areas, including 6 lounges, one of which was a smoking lounge, and a conservatory. General maintenance management remains with central maintenance personnel employed by Lancashire County Care Services. As a result of this small maintenance problems remain low priority and there were a number of problems that were ongoing from previous inspections, such as a poor hot water supply and a cold radiator in one bedroom. The resident concerned had stated the room was cold. These must be repaired with priority and the Commission must be notified when this has been carried out The home was furnished to a good standard, and the bedroom furniture in particular was new, tasteful and in good condition. This included at least a desk, chair, wardrobe and chest of drawers in each room. The bedrooms were all tastefully decorated and some carpets had been replaced with easy to clean but fashionable wooden floors, to minimise odours. However most bedrooms did not have a bedside light. Residents said they liked their bedrooms. They could lock their door safely, and those who could manage a key were provided with one. All rooms were fitted with a call bell to summon staff help. Bathing facilities were satisfactory, and hot water taps had safety valves fitted to prevent residents being accidentally scalded. Hot water temperatures were tested at random outlets and found to be within an acceptable range. All radiators throughout the home were covered with protective guards. A good standard of hygiene was seen throughout the home and the number of cleaning hours had been increased following the previous inspection. However a number of bedrooms still had unpleasant odours. Laundry facilities and procedures were good, and the laundry was equipped with washing machines designed for heavy soiling and infection control. Two new laundry assistants were employed following the previous inspection. Lower Ridge HFE DS0000035131.V313859.R01.S.doc Version 5.2 Page 20 Lower Ridge HFE DS0000035131.V313859.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a site visit to this service. The level of staffing in general enabled the needs of the residents to be met and staff had the necessary qualifications. Recruitment and selection procedures did not fully comply with the Regulations, but residents had confidence in the staff working at the home. Staff Induction and training was developing according to the needs of the staff and residents. EVIDENCE: The staffing levels, and compliment of staff, appeared to meet the needs of the residents. Since the previous inspection, cleaning hours had been increased and 2 laundry assistants had been appointed. All those residents spoken with stated that they felt well looked after, and 3 relatives stated that there was always enough staff on duty. However one relative who completed a comment card stated that there wasn’t always enough staff on duty. On the day of the inspection, on the afternoon and evening shift, there was a member of staff short due to short notice sickness. The home had a high percentage of staff with the relevent qualifications. Documentary evidence, including the pre inspection questionnaire, showed that 21 out of 23 care staff were qualified to at least NVQ level 2, that is 91 . Staff records showed that staff recruitment procedures could be improved. Two recently appointed members of staff had commenced work in the home Lower Ridge HFE DS0000035131.V313859.R01.S.doc Version 5.2 Page 22 following the reciept of a Protection of Vulnerable Adult check, but prior to the receipt of the full criminal record check (the CRB). For one of these members of staff the CRB check was not issued until about two and a half weeks after the Induction was completed. For one member of staff, one of the references was not signed and dated so it was not clear who it was from. For the other member of staff there was no documentary evidence that the most recent previous employer in a care home had been asked for a reference. There was also no records of previous relevant qualifications. Records showed that staff had completed training in accordance with Government guidelines including, infection control, food hygiene, a 4 day first aid course, risk assessment and medication. Future planned training included, moving and handling and dementia awareness. There was a rolling programme of food hygiene and first aid training. Lower Ridge HFE DS0000035131.V313859.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence, including a site visit to this service. The home was managed by an experienced and qualified manager who was well supported by an area manager. Quality assurance policies and procedures were implemented which took into account the views of residents and relatives. Residents money was managed safely and efficiently and the health and safety of both residents and staff were promoted. EVIDENCE: The registered manager was experienced and had completed the Registered Managers Award. She had worked as the manager at Lower ridge for about 3 years and had many years employment with Lancashire County Care Services. She had also completed a professional trainers qualification. An area manager undertook monthly unannounced monitoring visits as required under Regulation 26 of the Care Homes Regulations. Lower Ridge HFE DS0000035131.V313859.R01.S.doc Version 5.2 Page 24 The home carried out the Local Authority’s quality monitoring policy. Residents and relatives’ questionnaire surveys were undertaken every 6 months to ensure the views of the residents were used to develop the service. The results of these surveys were analysed at head office and an action plan devised. On the information supplied to the Commission there was a high level of satisfaction with all aspects of the service. Residents’ money was managed safely. Those residents who were able managed their own personal spending money. The spending money of some residents was managed by staff, and stored securely and separately in the home’s safe. Individual’s accumulated money could be transferred to the “temporary savings account” at head office. Appropriate records of receipt of money, that given to residents, spending/withdrawals on residents’ behalf and the balance remaining were kept . A spot check showed that the amount of the money in the safe balanced with the amount on the records. Recipts of items purchased were kept. The home provided a safe environment for residents and staff. The pre inspection questionnaire and records kept in the home showed that all appliances, installations and equipment had been serviced and maintained appropriately. The fire office visited the home in March 2006 and the fire alarms were tested weekly. Appropriate fire records were kept. Hot water was tested at random and found to be at a safe temperature and radiators and pipes were covered. Staff undertook training in infection control, first aid, food hygiene and moving and handling. Lower Ridge HFE DS0000035131.V313859.R01.S.doc Version 5.2 Page 25 Lower Ridge HFE DS0000035131.V313859.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 1 2 2 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X x 3 2 2 2 STAFFING Standard No Score 27 3 28 4 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Lower Ridge HFE DS0000035131.V313859.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP3 Regulation 14(1) Requirement The registered person must not admit anyone to the home before an assessment of need is carried out, and enough information is obtained on all health, personal and social care matters, including mental health matters, to make sure the home is suitable for the purpose of meeting the residents’ needs. (Previous timescale of 08/03/06 not met) All residents must have a care plan and one must be developed for the resident identified by the time scale shown The care plans must contain sufficient detail of all aspects of how the residents’ health, personal and social care is to be provided, including mental health issues and spiritual matters. It should reflect residents’ preferences and choices. All sections of the care plan must be completed. (Previous timescale of 08/03/06 not met) DS0000035131.V313859.R01.S.doc Timescale for action 17/11/06 2. OP7 15(1) 17/11/06 3 OP7 15 (1) 30/11/06 Lower Ridge HFE Version 5.2 Page 28 4 OP8 13(4)(b) (c) 5 OP9 13(2) 6 OP9 13(2) & 171,a,3,i 7 OP9 13(2) 8 OP9 13(2) 9 OP9 13 (2) 10 11 12. OP9 OP9 OP25 13 (2) 13(2) 23(b) Risk assessments must be carried out, and appropriate management identified, for residents identified at risk of falling. Policies and procedures must be developed for PRN (when required) medication and drug errors. Accurate records must be kept of all medication received in to the home, leaving the home and administered, including homely remedies and medication administered by the residents themselves. Risk assessments must be undertaken with those residents who administer their own medication The registered person must ensure that the GP or pharmacist sanctions the use of homely remedies The registered person must ensure that the MARs have identical instructions to those of the prescriber, unless there is a supporting explanation and GP consent. Oxygen cylinders should be stored securely at all times. The temperature of the medication storage area should be regularly monitored. The registered provider must make sure that the repairs in the bedroom identified (hot water and radiator) are completed within the timescale stated. The Commission must be notified. (Previous timescale of 08/03/06 not met). All areas of the home must be kept free from offensive odours. The registered person must ensure that staff recruitment DS0000035131.V313859.R01.S.doc 30/11/06 30/11/06 17/11/06 17/11/06 17/11/06 17/11/06 30/11/06 30/11/06 30/11/06 13 14. OP26 OP29 16(2)(k) 19 (1) Schedule 30/11/06 30/11/06 Page 29 Lower Ridge HFE Version 5.2 2 procedures are in accordance with the Care Homes Regulations, and that staff do not commence work in the care home until full CRB checks have been obtained, that references have been obtained from the most recent employer and dated and signed and that there is documentary evidence of relevant qualifications obtained. 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 OP5 Good Practice Recommendations It is strongly recommended that prospective residents have an opportunity of visiting the home prior to admission or have an opportunity of meeting the manager and or other staff. The use of bedrails should be kept under review with the interested parties and this should be undertaken with the resident identified. The criteria for when PRN medication should be given, and variable doses, should be explained on the sheets provided. Hand written alterations and additions to the MAR sheets should be signed by two people (witnessed) and dated. A separate supply of eye drops should be obtained for each eye. Residents’ creams should be stored securely in people’s rooms. The secondary dispensing of the medication of the resident identified should cease. It is recommended that the registered person establishes which residents would like a table lamp for their bedroom. 2. 3. 4 5 6 7 8 OP8 OP9 OP9 OP9 OP9 OP9 OP24 Lower Ridge HFE DS0000035131.V313859.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection East Lancashire Area Office 1st Floor, Unit 4 Petre Road Clayton Business Park Accrington BB5 5JB 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. Extracts may not be used or reproduced without the express permission of CSCI Lower Ridge HFE DS0000035131.V313859.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!