Inspection on 28/07/06 for Ravenswood

This inspection was carried out on 28th July 2006.

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

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Ravenswood 30/09/09

Ravenswood 06/07/09

Ravenswood 03/04/09

Ravenswood 18/07/08

Ravenswood 03/02/06

Ravenswood 28/10/05

Ravenswood 25/01/05

Ravenswood 05/05/04

Ravenswood 05/02/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Ravenswood Lansdown Road Westal Green Cheltenham Glos GL50 2JA Lead Inspector Mr Simon Massey Key Unannounced Inspection 28th July & 2nd August 2006 10:00 Ravenswood DS0000016553.V303290.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 Ravenswood DS0000016553.V303290.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. Ravenswood DS0000016553.V303290.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ravenswood Address Lansdown Road Westal Green Cheltenham Glos GL50 2JA 01242 256900 01242 269033 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) Gloucestershire Community Care Group Mrs Mavis Ann Gardner Care Home 9 Category(ies) of Learning disability (9) registration, with number of places Ravenswood DS0000016553.V303290.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Manager to complete NVQ level 4 Registered Managers Award by 2005. Manager to attend a Health & Safety for Managers course Date of last inspection 3rd February 2006 Brief Description of the Service: Ravenswood House provides residential care for adults with learning disabilities who may present with behaviour that challenges. The home is a large detached house situated on a main road close to Cheltenham town centre. The location enables service users to access a range of local amenities. Accommodation is provided on the ground and first floor. On the ground floor there are three bedrooms, a large lounge, a separate dining room, kitchen, laundry, toilet and bathroom. On the first floor there are six bedrooms, one of which has en-suite facilities, a shower room, bathroom, office and sleeping in room. To the rear there is an attractive secure garden. To the front of the property there is a car parking area. The home has its own people carrier. Ravenswood is one of three homes owned by Gloucestershire Community Care Group. The home’s Statement of Purpose and Service User Guide provide information as to the services that the home provides. The current fee range for the home was not available at the time of the inspection. Ravenswood DS0000016553.V303290.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place on 28th July and 2nd August 2006 and lasted for a total of 10 hours. The home was previously visited on 3rd February 2006. This inspection looked at the key national minimum standards and was unannounced, though the second visit was arranged in conjunction with the Registered Manager. This inspection was supported by members of the care staff, the Deputy Manager and the Manager. The Inspector had contact with all of the service users who live in the home. Staff were observed supporting the service users. The inspector also spoke with three parents who were visiting the home at the time of the inspection visits. Records relating to care planning, medication, health and safety and staffing were examined. An inspection of the premises was also undertaken. What the service does well: What has improved since the last inspection? What they could do better: The home could implement more structured and formal quality assurance processes. The manager and staff need to be fully aware of the requirements under Reg. 37 to inform the Commission of incidents within the home. Ravenswood DS0000016553.V303290.R01.S.doc Version 5.2 Page 6 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. Ravenswood DS0000016553.V303290.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Ravenswood DS0000016553.V303290.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Pre-admission assessments and the home’s admission policy help ensure the appropriate people are admitted to the home whose needs can be met. EVIDENCE: There have been no admissions to the home since the previous inspection, but the home has an admission policy in place that complies with the regulations Information and assessments are prepared and collected or completed, and people have an opportunity for visits and overnight stays before a decision is made on admission. All admissions are subject to a trial period. Ravenswood DS0000016553.V303290.R01.S.doc Version 5.2 Page 9 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 & 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Service users have care plans in place that reflect their needs and are reviewed regularly. The home also attempts to provide this information in a format understood by the individual service users. Care plans and risk assessments support the service users to make choices and decisions about their daily activities. EVIDENCE: A sample of care plans were examined and these were seen to be detailed and regularly reviewed. Extensive use is made of symbols and pictures. All service users have nominated key-workers who, with the service users, are involved the reviewing of plans. Evidence from talking to service users, staff and parents showed that people are supported to make decisions and choices about their daily lives and routines. Risk assessments are in place, which are reviewed and provide guidance to staff. Ravenswood DS0000016553.V303290.R01.S.doc Version 5.2 Page 10 Improvements have been made in the identifying and recording of individual goals and objectives. All staff spoken to were able to demonstrate an understanding of the care plans and the individual needs of the service users. Improvements have also been made to the recording of incidents of challenging behaviour, with detailed accounts being recorded of any incidents that may occur. The home have been supporting and caring for one service user who has been presenting increased challenging behaviour over the previous few months. The management of this occasionally requires restraint to be used in the form of leading the service user to their room. Clear guidelines are provided for staff and staff interviewed demonstrated a professional understanding of the incidents and the appropriate techniques required to de-escalate and manage the situation. However the Commission had not been informed of the deteriorating illness or the frequent restraint being employed. Clarification was provided to the Manager over this issue and a requirement has been made in relation to this. A good standard of daily recording was seen, with information being easy to access. All files seen were up to date and well organised. Ravenswood DS0000016553.V303290.R01.S.doc Version 5.2 Page 11 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 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home support and encourage service users to live a lifestyle that is based on individual choice according to ability, individual interests and appropriate risk assessments. The service has positive and professional relations with parents and relatives. EVIDENCE: The records show that over the previous months staff have supported a number of activities in and away from the home. Staff commented that extra staffing could be provided if required, to support any additional activities that were planned. Trips and activities undertaken included cinema, pubs, music therapy, trampolining, line dancing and the opportunity of holidays and short breaks. Service users interviewed expressed satisfaction with the range of activities and outings they are supported to undertake. All service users have a weekly timetable or routine that they follow in terms of their daytime activities. Ravenswood DS0000016553.V303290.R01.S.doc Version 5.2 Page 12 The kitchen was well stocked with fresh and packaged food and the menus show that a healthy diet is encouraged but individual choice is respected and encouraged. Staff, service users and parents all commented that the food was of a good standard, and that service users who wish to can have an involvement in planning and preparation. Ravenswood DS0000016553.V303290.R01.S.doc Version 5.2 Page 13 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 & 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Care plans and guidance ensure that people’s physical and emotional needs are met. Health needs are closely monitored and appropriate professional input provided to meet the needs of the service users, and provide advice and guidance for the staff team. EVIDENCE: The personal files contain information and guidance about how individual personal support should be provided. Following some feedback from newly appointed staff, additional guidance around personal care need is being provided. In order to promote independence for one service user a bell has been fitted in one of the bathrooms. This allows privacy and ensures safety. The home has regular contact and input from the Community Learning Disabilities Team for several of the service users. Records are kept of all health appointments, and when necessary information and guidance is transferred to the individual files. Ravenswood DS0000016553.V303290.R01.S.doc Version 5.2 Page 14 The medication storage and administration system was examined and found to be in order. There was evidence that medication is regularly reviewed. All staff receive training before they are permitted to administer medication. The home has recently had a pharmacy inspection visit from their dispensing chemist, this report described their practice as “excellent”. Ravenswood DS0000016553.V303290.R01.S.doc Version 5.2 Page 15 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&23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Service users are encouraged and supported to express their opinions on all aspects of their care. Relatives are able to raise concerns or issues openly with the Manager or the Provider. Physical intervention training that is being provided should improve staff awareness and provide greater protection for service users. EVIDENCE: One service whose changing needs have produced increased challenging behaviours has been receiving the required input from outside professionals and also a caring and consistent approach from the staff. Whilst the situation is being managed by the home in an appropriate and professional manner a requirement has been made in relation to the notification the Commission have received in relation to this. The home has accessed some training from BILD relating to managing of challenging behaviours but some staff considered that this had not entirely met their needs. The inspector was informed that further training was being provided in the form of “ Positive Response Training”. This will provide guidance and training to the staff team in the techniques of de-escalation and appropriate techniques for the physical restraint that is required. The home has been required to inform the Commission of when this training will take place. Ravenswood DS0000016553.V303290.R01.S.doc Version 5.2 Page 16 Three parents were interviewed during this inspection and all were very positive about the care provided. They were all confident about raising concerns or making complaints, and that these would be listened to and acted upon. Confidence was expressed in the management of the home and the protection of the service users. People were not fully aware of the formal complaints procedure but were clear about who they would approach. Ravenswood DS0000016553.V303290.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Service users are provided with a clean, homely and comfortable environment EVIDENCE: All parts of the home were inspected and found to be in a good state of repair. Alterations are being made to the dining and living rooms, which will provide more private space for service users to meet friends and families. The individual rooms are decorated according to personal choice and reflective of the individuals and interests of service users. Service users expressed satisfaction with their rooms and confirmed they were afforded privacy from staff and other service users. The garden provides a well maintained and comfortable area that is also secure and safe for the service users. All parts of the home were clean and hygienic Ravenswood DS0000016553.V303290.R01.S.doc Version 5.2 Page 18 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 & 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. A well-organised and motivated staff team meets the service user’s needs, though regular working by staff of long, or double shifts, could compromise the quality of care being provided. Service users are protected by the home’s recruitment policy. EVIDENCE: Four care staff were spoken during this inspection and all demonstrated a good understanding of their roles and the needs of the service users. People were positive about team working and support from the management. Staff stated they were happy to raise concerns or issues and that these were dealt with appropriately by the management. Staff stated the staffing levels were adequate to meet the general levels of activities, though recently some compromises had to be made due to the increased needs of one service user, who was requiring increased support. Staff were up to date with the required statutory training and were receiving regular supervision. Two staff have completed NVQ training and another has started. Ravenswood DS0000016553.V303290.R01.S.doc Version 5.2 Page 19 Staff were observed supporting and interacting with service users in a positive and caring manner and it was evident that staff are motivated to work as a team to meet the service user’s needs. The rotas show that staff are occasionally working long double shifts, often including a sleep duty as well. Two staff spoken to stated they were happy to do these shifts and that they thought it did not affect the quality of care provided. While the shift patterns are not a breach of regulations in themselves, regular working of excessively long shifts is not good practice. The inspector has recommended again that this is closely monitored by the home to ensure that service users quality of care is not adversely affected. Ravenswood DS0000016553.V303290.R01.S.doc Version 5.2 Page 20 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 & 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The management team provide the home with direction and leadership and ensure that the administrative processes are effective. The home has some quality assurance systems in place but these could be expanded and improved. Effective health and safety monitoring helps to provide a safe environment. EVIDENCE: The Registered Manager has now completed their NVQ 4 in Care and Registered Managers Award and was waiting for final conformation to arrive. Confirmation of this will be provided to the Commission. The administration of the home is well organised and all records were up to date, with information being easily accessible. Ravenswood DS0000016553.V303290.R01.S.doc Version 5.2 Page 21 Feedback from newly inducted staff has resulted in the guidance around personal care being improved. All staff after completing their induction are given an opportunity to reflect upon their induction period and suggest any ideas. The Provider and the Director of Operations visit the home regularly and Reg. 26 reports are completed and sent to the home. The Manager and Deputy stated they were well supported by the Provider and were happy to raise concerns or issues. The home also has regular visits from parents and relatives. A number of questionnaires distributed to staff, service users and relatives by the inspector were returned. These all provided positive comments about the care provided. The home have also distributed some questionnaires to outside professionals. It is recommended that the home should consider a more structured and formal process to quality assurance. Health and safety within the home is being monitored. All fire safety checks and servicing have been completed. Following fire drills staff have recorded details about the response of the service users for future reference. This is good practice. Electrical testing and Gas certificates were in place and up to date. A record is kept of fridge and freezer temperatures and also the water is regularly tested. All this information is correctly recorded. The home has had a recent inspection form the Environmental Health Department and the report was supplied to the Commission. This was satisfactory and action has been taken on the points raised. All staff are up to date with the required statutory training. Ravenswood DS0000016553.V303290.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 x 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 x LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 X 3 X X 3 x Ravenswood DS0000016553.V303290.R01.S.doc Version 5.2 Page 23 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA23 Regulation 37 Requirement The home must ensure that all notifiable incidents are reported to the Commission under the requirements of Reg. 37 The home must provide information to the Commission confirming when the physical intervention training will be provided Timescale for action 30/09/06 2. YA23 18(c )i 30/09/06 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 YA33 Good Practice Recommendations The home should continue to review the policy of staff occasionally working double and long shifts Ravenswood DS0000016553.V303290.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB 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 Ravenswood DS0000016553.V303290.R01.S.doc Version 5.2 Page 25 - 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!