CARE HOME ADULTS 18-65
Ravenswood Lansdown Road Westal Green Cheltenham Glos GL50 2JA Lead Inspector
Mr Simon Massey Unannounced Inspection 28th October 2005 12:30 Ravenswood DS0000016553.V264575.R01.S.doc Version 5.0 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.V264575.R01.S.doc Version 5.0 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.V264575.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Ravenswood Address Lansdown Road Westal Green Cheltenham Glos GL50 2JA 01242 256900 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.V264575.R01.S.doc Version 5.0 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 25th January 2005 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. Ravenswood DS0000016553.V264575.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place over 4 hours. The inspector spoke with the registered manager, care staff and also met 7 of the service users. Evidence was taken from documentation and records and an inspection of the premises was also completed. Records relating to care plans, health and safety, and staffing were examined. At the time of the inspection the home was engaged in a dialogue with the fire service about safety issues and a subsequent meeting has been arranged for both parties that the inspector will attend. The inspector has left a number of quality assurance questionnaires at the home that it is hoped will be completed and forwarded to the Commission. The inspector was grateful to the service users and staff team for their open and friendly approach to this unannounced inspection, which was the inspectors first visit to the home. What the service does well: What has improved since the last inspection?
This was the first visit to the home by the inspector and it wasfound that the requirements of the previous inspection had been met, with the exception of the issue of staffing records. It was not possible to check these records during this visit, as these are held centrally. However the manager stated that the correct checks had been completed before the most recently contracted staff commenced employment in the home. The home is now fully staffed.
Ravenswood DS0000016553.V264575.R01.S.doc Version 5.0 Page 6 The home has further improved the use of symbols in its care plans to facilitate better understanding for service users. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Ravenswood DS0000016553.V264575.R01.S.doc Version 5.0 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.V264575.R01.S.doc Version 5.0 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): None of these standards were examined during this inspection. EVIDENCE: The home is currently full and there have been no admissions over the previous 12 months. Ravenswood DS0000016553.V264575.R01.S.doc Version 5.0 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 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. EVIDENCE: All service users have care plans in place and these are detailed and are being reviewed at appropriate intervals. The plans contain details of all aspects of care needs, giving guidance to staff as well as presenting an all round picture of the individual service user. The staff team have made good use of symbols and work is currently being undertaken to develop this format further. Example of risk assessments on road safety, personal care and independence were seen. These were up to date and being regularly reviewed. The manager stated that service users have Individual Personal Plans, which identify goals and objectives. The inspector recommended that these goals and objectives could be incorporated into the care plan and reviewed as part of this process. These should contain dates, timescales and the person responsible for actioning.
Ravenswood DS0000016553.V264575.R01.S.doc Version 5.0 Page 10 Some service users can occasionally present challenging and aggressive behaviour. There is a need for the home to ensure that greater detail of any incident is recorded. This must include a description of the actual event and not just a statement saying that someone has been aggressive or assaulted someone. Concerns about the training provided for staff to meet some of the present needs are included in the staffing section of the report. The home has regular house meetings for service users, at which decisions are made about planning activities and people are, where possible, supported to express their views. The care plans also contain information about personal likes and dislikes. Ravenswood DS0000016553.V264575.R01.S.doc Version 5.0 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): 12,13,14,16 & 17 The home is committed to providing individual lifestyles for service users based on their needs and wishes. People have individual routines that have a reasonable amount of variety. EVIDENCE: Evidence was seen that service users are supported to undertake a range of activities in the local community and also organised activities within the home. Daily and weekly routines are displayed on the notice board, and recording in individual records also document trips out and visitors to individual service users. Service users have been supported to have holidays and some have been provided with the option of having long weekends away rather than a whole week at a time because this better meets their needs. One staff member is employed as an “outreach” worker and works one day a week in this role providing specific support to the younger male service users.
Ravenswood DS0000016553.V264575.R01.S.doc Version 5.0 Page 12 Service users are supported to use their bedrooms to follow their interests, these being equipped with items and decoration that reflect personal interests and hobbies. Service users are encouraged to play a role in the daily tasks and chores within the house as far as their abilities allow and people were also seen enjoying the privacy of their own rooms. Two service users spoken to said that their privacy was respected by the staff and other service users. The kitchen was well stocked with fresh and frozen produce and the menus appeared varied. The home had a “healthy eating plan” in place that provides guidance to staff and service users. Certain foods are prepared in specific ways to meet individual needs. All food was correctly stored and appropriately labelled. Ravenswood DS0000016553.V264575.R01.S.doc Version 5.0 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 The home provides a good standard of personal care and support and has systems in place for monitoring and recording of health needs. EVIDENCE: The Care Plans and personal files provided information and guidance on what personal care is to be provided and how this should be delivered. Recording showed that outside professionals are used from the local Community Learning Disabilities Team to support staff and service users. There is recording of attendance at various appointments such as GPs and Dentists. Staff have now completed medication training following the requirement at the previous inspection. Ravenswood DS0000016553.V264575.R01.S.doc Version 5.0 Page 14 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 The home appears to provide a safe and caring environment but action is required to safeguard this area and ensure that documentation informs practice and vice versa. Training needs to be provided for staff to ensure that best practice is followed in the managing of some challenging behaviours. The recording of aggressive or challenging behaviour needs to be recorded in more detail. These actions will further ensure that service users are protected and their best interests are respected. EVIDENCE: The inspector identified concerns about staff training in relation to the management of challenging behaviour and these are detailed in the staffing section of the report. These must be addressed before Standard 23 can be fully met. Staff have completed some training in relation to protection issues, both through in-house discussion and NVQ work. Service user finances were not examined during this inspection. There have been no complaints recorded during the previous 12 months, either in the home or to the Commission. The regular house meetings provide an opportunity for service users to raise issues or concerns, though due to communication difficulties some people would require support to do this. Service users appeared comfortable and confident in their home and there was evidence of positive and relaxed interaction with staff. Ravenswood DS0000016553.V264575.R01.S.doc Version 5.0 Page 15 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): 24,25,26&30 The home provides a comfortable and homely environment with service users being provided with accommodation that they can personalise according to inddividual taste and preference. EVIDENCE: The home was clean and generally well maintained throughout. Individual bedrooms were seen and these were nicely decorated and equipped with personal belongings. Two service users spoken to expressed satisfaction with their rooms. The rear garden is secure and well maintained and a new summerhouse has recently being erected that will provide additional facilities for activities as well as improve the outside communal area. The requirements made in relation to the environment from the last inspection have all been actioned by the home. Service users now have inventories in their files detailing any furniture or personal items they have purchased for their rooms. Ravenswood DS0000016553.V264575.R01.S.doc Version 5.0 Page 16 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): 33, 34, & 35 Further training needs to be provided for staff in the management of challenging behaviour. EVIDENCE: These standards were not examined in detail during this inspection but a requirement and recommendation has been made in relation to the following. The manager stated that the home does not employ physical restraint techniques but there is an occasional need for physical intervention. This may involve guiding a person to their room or preventing some one from being injured. The manager stated that the home use de-escalation techniques and approaches to manage situations. It is evident from recording and discussion with the manager that the staff team have managed some difficult behaviours over the previous 12 months. Records show that some interventions have resulted in injuries to staff. The inspector identified the following concerns. Staff should not be using any physical intervention techniques for which they have not received training and also for which there is no agreed protocol in place. The manager stated that they had completed training in this area in their previous employment but neither they nor the staff group have undertaken training in this specific area. It is recommended that the staff team are provided with training in managing challenging behaviour. This ideally should
Ravenswood DS0000016553.V264575.R01.S.doc Version 5.0 Page 17 be provided by trainer accredited through BILD. This training covers the managing of behaviours through de-escalation and low arousal and would also provide the staff team with training in specific restraint techniques that have been assessed as being safe and appropriate to be employed in the home. The inspector believes that this training is required to ensure the staff are best able to meet the needs of the present service users. Staff training records were not seen but the manager stated that all the current staff team were up to date with the required statutory training. This area will be looked at in more detail at the next inspection, including induction and NVQ provision. The home has had regular staff meetings that are recorded. Supervision records were not examined during this visit but the manager stated that all staff were now receiving regular supervision sessions. The home is currently fully staffed and rotas showed that the correct staffing levels are being maintained. This means a minimum of 3 staff on duty with extra cover being provided by the manager working a certain number of day shifts. The manager explained that the main staff files are kept in the organisations main office in central Cheltenham. The inspector reminded the manager that the home must keep certain staff details within the home. This should be an up to date list giving basic details including start dates, addresses and contact details and a photograph. Ravenswood DS0000016553.V264575.R01.S.doc Version 5.0 Page 18 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 The home has been competently and effectively managed since the previous inspection. Leadership is provided to the staff, who appear to work well as a team. EVIDENCE: The manager stated that they are well supported by the Provider who visits regularly and also completes the required Reg 26 inspections. The manager explained their efforts to improve the care planning with increased use of symbols and also by involving key-workers in formal reviews of care plans every 3 months in supervision. All safety checks have been completed and recorded and potentially hazardous materials are securely stored. The home is currently in discussion with the fire service about the homes fire safety assessment and a further meeting has been arranged which the inspector will attend. Ravenswood DS0000016553.V264575.R01.S.doc Version 5.0 Page 19 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X X X X x Standard No 22 23 Score 3 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 x 3 x Standard No 24 25 26 27 28 29 30
STAFFING Score 3 3 3 X X X 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 X 16 3 17 Standard No 31 32 33 34 35 36 Score X X 3 2 2 x CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Ravenswood Score 3 3 X x Standard No 37 38 39 40 41 42 43 Score 3 X 3 X X 3 x DS0000016553.V264575.R01.S.doc Version 5.0 Page 20 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 12(1)13(7,8)18(1)ci Requirement Timescale for action 28/02/06 2 YA23 13(8) 2 YA34 17(2)schedule4 The home must provide training for staff in the area of managing challenging behaviours, as described in the text The home must 31/12/05 ensure that all incidents involving aggressive or challenging behaviour are recorded in sufficient detail and the Commission notified The home must 31/01/06 ensure that the required staff details are available within the home. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No.
Ravenswood Refer to Good Practice Recommendations
DS0000016553.V264575.R01.S.doc Version 5.0 Page 21 1 2 Standard YA6 YA23 The home should include goals and objectives identified with or by service users more prominently in the care plans The home should provide the training identified in Req 1 from a training organisation that is accredited by BILD Ravenswood DS0000016553.V264575.R01.S.doc Version 5.0 Page 22 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
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