Inspection on 06/07/09 for Ravenswood

This inspection was carried out on 6th July 2009.

CQC found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Ravenswood 30/09/09

Ravenswood 03/04/09

Ravenswood 18/07/08

Ravenswood 28/07/06

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 25/11/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Ravenswood Lansdown Road Westal Green Cheltenham Glos GL50 2JA     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Simon Massey     Date: 0 6 0 7 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 26 Information about the care home Name of care home: Address: Ravenswood Lansdown Road Westal Green Cheltenham Glos GL50 2JA 01242256900 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Gloucestershire Community Care Group care home 9 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 9 Manager to attend a Health & Safety for Managers course Manager to complete NVQ level 4 Registered Managers Award by 2005. Date of last inspection Brief description of the care home 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 Care Homes for Adults (18-65 years) Page 4 of 26 Brief description of the care home the services that the home provides. The current fee range for the home was not available at the time of the inspection. Care Homes for Adults (18-65 years) Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This inspection was undertaken on 10/07/09. The Inspector met with the acting manger, the Provider, several members of the care staff team and four of the people living in the home. Records relating to care planning, staff recruitment and training and health and safety were examined. An inspection of the environment was also undertaken. Care Homes for Adults (18-65 years) Page 6 of 26 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 7 of 26 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 8 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Statement of Purpose and Service User Guide provides accurate information but an increased use of pictures and symbols may benefit people living in the home. Evidence: There have been no admissions to the home since the previous inspection. The home currently has two vacancies. The Statement of Purpose and Service User Guide were being reviewed at the time of this inspection and the ongoing work was shown to the Inspector. An increased use of symbols and pictures is being utilized. Care Homes for Adults (18-65 years) Page 9 of 26 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The implementation of the person centered planning system is providing more involvement for people in the planning of their care and support and improved choices for people living in the home. Evidence: Improvements have been made to the care planning system to develop the person centered approach being used. Staff have also undertaken training in this area, and people spoken to demonstrated their understanding of the approach being developed within the home. The plans seen make good use of symbols and pictures and were clearly organized and covered all aspects of care and support that that was required. There have been regular meetings with the people living in the home to identify their wishes and improve their ability to make choices and decisions about leisure and daily vocational activities. Minutes are taken form client meetings and one staff member has the responsibility to read back through these with everyone to promote understanding Care Homes for Adults (18-65 years) Page 10 of 26 Evidence: and the effectiveness of the meetings. There was evidence of regular recording being completed, though some records were more detailed than others. The acting manager stated that when increased management hours were provided, monitoring of some aspects of the recording would be increased. There were a number of person centered risk assessments in place and the samples seen were up to date and had been appropriately reviewed. Care Homes for Adults (18-65 years) Page 11 of 26 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home supports the service users to develop individual lifestyles and plan for the future by encouraging the development of independence skills Evidence: People spoken to all said they had enough to do in the evenings and weekends and that they were happy with their daily and weekly routines. One person described their work experience and how much they enjoyed this. There has been an increase in the amount of trips out into the community being supported. This has been helped with improved staffing levels and also other changes such as the provision of bus passes for everyone. One person has an excellent programme in place supporting them to travel independently on the bus, by building their knowledge and confidence. Care staff have started completing monthly summaries on each person living in the home in relation to activities, or events, though not all of these had been completed at the time of the Care Homes for Adults (18-65 years) Page 12 of 26 Evidence: inspection. There was evidence from recording and interviews with staff, that there has been an increase in recent months in activities in the home itself and also in the community. More trips out have been supported, including brief walks, and short trips out in the vehicle if this is appropriate. People are supported to access the kitchen and be involved in food preparation and menu planning. People were observed making their own drinks and helping to prepare meals. There are some restrictions around the use of the kitchen for health and safety reasons and some of these issues were discussed with the acting manager. It is recommended that staff look at developing individual risk assessments for each person in regard to the use of the kitchen. The kitchen was well stocked with fresh and packaged food at the time of the inspection and staff and service users stated that the food was of excellent quality. People are provided with choice and staff demonstrated a good knowledge of the individual preferences of people and explained how they catered for this. Care Homes for Adults (18-65 years) Page 13 of 26 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples personal and health care needs are met, promoting their dignity and wellbeing. Good arrangements are in place for the handling of medication, promoting service users wellbeing and good practice from staff. Evidence: All medication was correctly stored and all records were up to date. There was excellent information provided for staff in relation to the medication being administered, and good use of symbols to improve the understanding of the people living in the home. There were regular audits being undertaken and staff are required to complete training before they administer medication. All medication had been reviewed within appropriate timescales. The home have accessed the services and input from the local Community Learning Disability Team. Advice and guidance was clearly recorded and staff demonstrated an awareness of the issues concerned and the needs that had to be met. Care Homes for Adults (18-65 years) Page 14 of 26 Evidence: People living in the home able to respond, said they were happy with the personal care they received, and there was clear guidance in the care plans as to how this was to be delivered. Everyone in the home has a Health Action Plan in place. The format provides good person centered information, including a health assessment and personal care guidance and protocols. People now all have individual health files. These files contain an annual health check that has been completed by their doctor. There was evidence that peoples health is correctly monitored and that outcomes are correctly recorded. One person was supported to attend the dentist on the day of the inspection and they appeared relaxed and happy with the support they had received. The outcomes from this visit were clearly recorded and information passed onto the other staff on duty in the afternoon. Care Homes for Adults (18-65 years) Page 15 of 26 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a safe environment for service users in which they are respected and treated with dignity. The planned training for staff in the management of challenging behaviors will further ensure that people living in the home are protected Evidence: Staff have undertaken training in protection issues and people spoken to were aware of how to raise issues and also how to make complaints and raise concerns. People living in the home spoken to stated they felt safe and were able to talk to staff about matters that concerned or worried them. People were observed as being relaxed and confident in their home and interacting positively with the staff on duty. The home has a policy of not using restraint and all staff confirmed that restraint is not used within the home. Staff explained how their knowledge of the service users means they can anticipate certain situations and react in a positive manner to diffuse a potential issue or divert someones attention with an alternative activity. All the staff team will be shortly be undertaking Positive Response Training which is aimed at providing guidance and input on the management of challenging behaviors. This training should improve the staff teams knowledge of low arousal and deescalation techniques. The home has received no complaints since the previous inspection Care Homes for Adults (18-65 years) Page 16 of 26 Evidence: Care Homes for Adults (18-65 years) Page 17 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users benefit from a home that is well maintained and decorated throughout and provides a comfortable homely environment. Service users are supported and encouraged to personalise their living space and are involved in decisions relating to the redecoration of the home. Evidence: The home is well maintained to a good standard and all people spoken with said they were happy with their individual accommodation. Various parts of the home have been decorated and some furnishings replaced. The home now has a separate quiet lounge, with the dining area being moved to the main living room. This has provided a communal area for activities that can be undertaken without interruption from other service users. All the individual bedrooms have been personlised according to personal preference and needs. The home was clean and hygienic throughout on the day of the inspection. Care Homes for Adults (18-65 years) Page 18 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are supported by an experienced and qualified staff team that relates well to the service users and promotes their safety and wellbeing. Evidence: There were sufficient staff on duty at the time of this inspection and the rotas showed that the correct levels were being maintained. There were three staff on duty, with one of these staff leaving to take two people on holiday for five days. One of the shifts was being covered by the acting manager. Comments about the management hours are made under the management standards. The home arranged additional support from another home run by the same Provider, to support a dental appointment for one person. The home is maintaining three staff per shift to support and provide care for seven people. There are also two days per week when the acting manager is working a day shift which provides additional cover. Steps have been taken to improve the monitoring and organizing of training for staff and the matrix in place showed that the majority of staff were up to date with the required statutory training with only a few updates outstanding. Increased staffing has helped with the organization of these. Five of the current staff have completed NVQ 2 or above. Previous requirements and recommendations have been made in respect of Care Homes for Adults (18-65 years) Page 19 of 26 Evidence: the provision of training in the management of challenging behaviors and the service has now organized some training called Positive Response Training, which all staff will be undertaking and is scheduled for the next two months. This is a positive development for the home. Whilst staff demonstrated a good knowledge of the individual needs of the people living in the home, the training will provide the opportunity for greater consistency. It should also improve the confidence for the manager and staff to develop and improve practice and decrease potential risks to staff and people living in the home. The manager has been organizing regular staff meetings, though this has been difficult at times due to staffing shortages earlier in the year. The minutes from these show there has been monitoring of practice and action taken to motivate and support staff to provide care and support to a high standard. Staff were also being encouraged to promote choice through the care planning system that is being implemented. People living in the home able to respond, said the staff were nice and friendly and people were observed interacting in a positive and appropriate manner. People appeared relaxed and confident within their home. One person said they enjoyed talking to staff and that they helped them with their problems. Another said they enjoyed going out with staff to play pool and go to the pub and that their key worker was their friend. Staff recruitment files were examined and were found to be in order with one exception. One persons file had only one reference in place and also there appeared to be contradictory evidence about the employment history. This was brought to the attention of the office manager who will investigate the omission. All the other required checks and records had been completed. Care Homes for Adults (18-65 years) Page 20 of 26 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users benefit from a home that is well managed and organized and has an acting manager in place that is committed to providing high quality care and support. Systems are in place that help to monitor and improve the quality of the service. Consistent support and supervision for the manager needs to be in place, and also regular scrutiny of the service, to ensure that progress is sustained and improved outcomes for people living in the home are achieved. There are a range of measures in operation that help to protect service users health and safety. Evidence: There is currently an acting manager in post, who was previously the deputy. They have provided leadership and direction to the staff team in relation to care planning and have provided good levels of support and supervision to the staff team. Staff and people living in the home were positive about the approachability of the acting manager and the response they get when raising issues or concerns. The acting manager also has worked at the home for a number of years and has an excellent Care Homes for Adults (18-65 years) Page 21 of 26 Evidence: knowledge of the needs of the people living in the home. The manager is currently working two day shifts per week and the Provider is also providing additional management cover. The Provider explained that they were currently recruiting another member of care staff, so that the acting manager could work full time on management responsibilities. Providing sufficient management cover has been requirement of the previous random inspection and also the Key Inspection undertaken in 2008. Examination of the rota showed that the staffing levels were being maintained and that the management hours for the acting manger were in place for the next two months. However two days a week is insufficient and it is essential that additional cover is provided by the Provider until the additional care staff have been recruited and the acting manager can move to full time management hours. The home must ensure that the registration application for the new manager is submitted to the Commission without delay. The Inspector was concerned that only one regulation 26 had been completed, though the Provider stated that he was planning to complete one on the day of the inspection. The acting manager had been provided with informal supervision and support but had received limited formal supervision, in fact only one in 2009. It was explained by the Provider that following changes in the company earlier in the year they were now fully involved in the running of the business but had had to concentrate initially on another home within the company. It was stated that regulation 26 inspections would now be completed monthly, the acting manager would receive regular formal supervision and would also be working management hours on a full time basis once another staff member had been recruited. A new format for completing surveys for people living in the home was shown to the Inspector and these were an improvement on the previous format being used and included the use of pictures and symbols. Surveys had also recently been circulated to relatives but had not yet been returned. Surveys are also being sent to other health professionals who are involved with the home. All fire safety testing and recording had been completed and recorded and the home had completed fire drills and recorded the outcomes and any concerns arising from these. Other records relating to health and safety were checked and found to be in order. Care Homes for Adults (18-65 years) Page 22 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 23 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 37 8 The home must appoint and submit a managers application for registration with the Commission. The service has had a considerable period with a registered manager and this must be addressed without delay 15/09/2009 2 39 18 The acting manager must receive regular formal supervision Until registration is complete the acting manager should receive guidance and support from the Provider on a regular basis. 15/08/2009 3 39 26 The Provider must complete regulation 26 inspections and submit copies of these to the Commission The service must receive regular scrutiny. The reports must contain details of the staffing levels and the 15/08/2009 Care Homes for Adults (18-65 years) Page 24 of 26 management hours worked in the home Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 17 The home should develop individual risk assessments on access and supervision in the kitchen. Care Homes for Adults (18-65 years) Page 25 of 26 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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