Inspection on 22/09/09 for Ribston House

This inspection was carried out on 22nd September 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Similar services:

2 Perhaver Park

The Vicarage

7 Hyde Road

St George`s

5 Seafield Road

Credence House

Radfords

Trevaylor Manor

Extracts from inspection reports are licensed from CQC, this page was updated on 18/02/2010.

Key inspection report CARE HOME ADULTS 18-65 Ribston House 210a Stroud Road Gloucester Gloucestershire GL1 5LA Lead Inspector Mr Paul Chapman Key Unannounced Inspection 22nd September 2009 09:00 Ribston House DS0000072629.V378114.R01.S.doc Version 5.3 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care home adults 18-65 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Ribston House DS0000072629.V378114.R01.S.doc Version 5.3 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Ribston House DS0000072629.V378114.R01.S.doc Version 5.3 Page 3 SERVICE INFORMATION Name of service Ribston House Address 210a Stroud Road Gloucester Gloucestershire GL1 5LA 01452 657577 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) New Beginnings (Gloucester) Ltd Balkarran Tokhai Care Home 8 Category(ies) of Learning disability (8), Physical disability (8) registration, with number of places Ribston House DS0000072629.V378114.R01.S.doc Version 5.3 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Learning Disability (Code LD) 2. Physical Disability (Code PD) The maximum number of service users who can be accommodated is 8. Date of last inspection New Service Brief Description of the Service: Ribston House is a purpose built establishment designed to meet the needs of people with physical and learning disabilities. The property is on the outskirts of Gloucester and close to local amenities. Accommodation is provided over 2 floors linked by a staircase and lift. On each floor there is a lounge, dining room, 4 en-suite bedrooms, an assisted bath/shower room and toilet. The kitchen is on the ground floor. The home is spacious and fully accessible to wheelchair users. There is specialist equipment throughout the home to support people with physical disabilities including overhead tracking in a number of bedrooms. The service provides people with a copy of the Statement of Purpose and a Service User’s Guide. Fee’s to live in the home vary dependant on individual’s needs. Ribston House DS0000072629.V378114.R01.S.doc Version 5.3 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use the service experience adequate quality outcomes. With this being a new service we (the CQC) did not send the registered manager questionnaires to distribute to staff and people living in the home. The registered manager completed an AQAA (Annual Quality Assurance Assessment). This document asks a service provider/registered manager to rate the services performance against the National Minimum Standards (NMS). A service provider/registered manager will be asked to provide evidence of what the service does well, what has improved in the past 12 months and their planned improvements for the next 12 months. Obviously with this service only being open for 3 weeks there was limited information available to the registered manager. In addition to providing evidence about how the home meets the NMS it also provides us with a Dataset (information about staffing, health and safety, complaints, the environment, policies and procedures and the people living in the home). On arrival at the service we were greeted by the manager who was present throughout the site visit. During our visit to the service we spent some time speaking with staff and people living in the home whilst also taking the opportunity to observe the interaction between staff and people they support. From this it was clear that staff are respectful and supportive to the people they work with. This was further confirmed when we spoke to staff individually asking them about their approaches to working in the home. We completed a tour of the premises with the manager which gave them an opportunity to discuss all of the specialist equipment and adaptations installed in the premises, and the future plans for development as more people move into the home. We examined the care of both people living in the home in depth, we looked at the admission/assessment process completed by the manager and the care plans created to identify and meet people’s needs. In addition to this we examined records relating to people’s health and financial management. Other records we examined included documents relating to health and safety, staffing and management of the service. The judgments contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. What the service does well: Ribston House DS0000072629.V378114.R01.S.doc Version 5.3 Page 6 The property is purpose built for this client group and provides people with the latest technology to meet their needs and promote their independence. People admitted to the home are thoroughly assessed before they are offered a service and this minimises the risk of people being admitted to the service whose needs cannot be met. Care plans and risk assessments are created at the time of a person’s admission to the service. Staff are respectful and supportive to the people living in the home. The home has a complaints procedure in place that enables people to make a complaint if they wish. Records seen by us showed that since their admission to the home people have active social lives being given a range of opportunities to take part in, if they wish. Daily record keeping by staff is good and enabled us to judge what choices people had been given and actions of the staff team. What has improved since the last inspection? What they could do better: The manager must ensure that risk assessments for each person are comprehensive and provide the reader with guidance on minimising the potential risk while enabling them to complete the activity. Care plans (including those for personal care) must be reviewed and developed to accurately reflect people’s needs and provide staff with detailed information enabling them to meet peoples needs consistently. Staff training records must be collated to show what training staff have completed and when updates maybe required. Ribston House DS0000072629.V378114.R01.S.doc Version 5.3 Page 7 When recruiting new staff the manager must ensure that a full employment history is recorded. A quality assurance procedure must be implemented that puts the wishes of people in the service at the centre of its development. 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 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. Ribston House DS0000072629.V378114.R01.S.doc Version 5.3 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Ribston House DS0000072629.V378114.R01.S.doc Version 5.3 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are thoroughly assessed before they are offered a place in the service and this minimises the risk of people being admitted whose needs cannot be met. EVIDENCE: This is a new service which was registered on March 26th 2009. At the time of this site visit only 2 people were living in the home and had moved into the service in the previous 3 weeks. We spent time speaking to 1 of the people about their admission, they confirmed that they had were aware of the service user’s guide and statement of purpose. Whilst examining records of both people’s care we found copies of the service user’s guide and the statement of purpose in their files. The Service User’s Guide can also be found in the entrance hall. Before both people were admitted to the service the manager completed a comprehensive assessment of their needs which included meeting them, Ribston House DS0000072629.V378114.R01.S.doc Version 5.3 Page 10 speaking to other professionals and using the information contained in their community care assessments. Ribston House DS0000072629.V378114.R01.S.doc Version 5.3 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are a range of care plans in place that identify peoples assessed needs but greater detail and further development is required to ensure that staff are able to meet peoples needs consistently and measure progress towards meeting goals. Staff support people to make choices day to day and the service is led by the needs and wishes of the people living there. The current risk assessments do not cover all of the potential areas where people could be put at risk. EVIDENCE: We examined the care packages for both people which showed that a range of care plans had been developed from the initial assessments completed by the manager. Ribston House DS0000072629.V378114.R01.S.doc Version 5.3 Page 12 As identified earlier in this report both people had only been admitted to the service in the 3 weeks before this site visit. As a result of this the detail in the care plans we examined was limited giving basic information about people’s needs and how staff should meet them. A concern raised from examining care plans was that there was an expectation that they should be reviewed weekly, but we were unable to find any evidence of this happening. We discussed this with the manager who agreed the reviews should have been recorded. The manager explained that with the staff he will review the care plans and develop them based on their experiences of people since they were admitted. It becomes a requirement of this report that care plans are developed that accurately reflect people’s needs and provide staff with guidance to meet those needs. When speaking to 1 of the people living in the home they said that so far it was a better place to live then where they had been previously. We asked about making choices/decisions, they stated that they are given choices on a day to day basis about the activities and food they wished to eat. During this site visit we were able to observe staff supporting both people, this provided us with good examples of people being supported to make choices and staff providing the appropriate support as required. Each day staff write notes detailing the activities people have completed, and what they have refused. This is seen as good practice. The notes we examined showed both people were offered a range of activities in and outside the home. We examined the risk assessments for each person. The manager had completed an initial assessment under the title of a ‘lifestyle risk assessment’. This document covered areas including personal care, health and mobility. There were no risk assessments in place for activities in the community, using the transport and cooking in house. Also there is potential for people to display behaviour that challenges and there were no risk assessments in place to address the potential risks. These shortfalls were discussed with the manager. Again, due to the short amount of time people have been living in the home these documents are at the early stage of development, but we felt that the risk assessments we have identified as not being present should be in place. It becomes a requirement of this report that these risk assessments are completed so that people are not put at unnecessary risks. Ribston House DS0000072629.V378114.R01.S.doc Version 5.3 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: 12, 13, 15, 16, 17 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home lead active lifestyles led by their needs and choices, staff provide support as required to enable people to complete activities. People are able to choose what they eat and are encouraged to be involved in its preparation and shopping for ingredients. EVIDENCE: As we have identified earlier in this report we spoke to 1 person about the activities they take part in and have a choice to do. In addition to speaking with this person we also spoke to staff and examined the notes staff complete each day recording among other things the activities people have taken part in. Ribston House DS0000072629.V378114.R01.S.doc Version 5.3 Page 14 In the 3 weeks prior to this site visit both people have been offered a range of activities, being given the choice as to whether they wish to complete them, or not. Examples of what people have been doing include; having free time, lunch out, walking to the local shop to buy a paper, attending a social club, going to the cinema, bowling, pub and bingo, having massages (from a qualified professional) and doing some cooking in house. 1 person has told staff they wish to go to a concert and this was being arranged at the time of this visit. Speaking with the manager they explained that over the coming weeks and months staff will give people the opportunity to say what other activities people may wish to complete, and support them achieving them. 1 person has been attending a local church since being admitted to the home. Friends and family are welcome to visit the home. We examined the records for food provided over the past 3 weeks which showed that each person has a choice of what they would like to eat. At this time the home is using a 4 week rolling menu, but the manager said this is always flexible and will be reviewed in the near future. As well as a good range of meals being available “in house” was saw records of people going out for meals locally and having take-aways. Both people have care plans identifying their nutritional needs and the manager must ensure that wherever possible appropriately qualified professionals are used to advise in this matter. This becomes a recommendation of this report. Ribston House DS0000072629.V378114.R01.S.doc Version 5.3 Page 15 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People’s health needs are addressed by appropriately trained health professionals. People’s personal care needs have been assessed but written plans to meet them do not provide staff with sufficient detail to do this consistently and measure changing needs. Medication administration is putting people at unnecessary risk. EVIDENCE: Both people require support with their personal care. Each person had a care plan written from the needs assessment completed by the manager. Examining the assessments it was clear that each person required substantial support from staff to manage their personal care, but care plans identified people’s needs but not the steps staff should take to meet people’s needs consistently. We spoke to the manager about this as although we appreciate that people have only been living in the home 3 weeks there should be more detailed Ribston House DS0000072629.V378114.R01.S.doc Version 5.3 Page 16 guidelines in place. It becomes a requirement of this report that these care plans are developed without delay to ensure that people’s needs are met. Since being admitted to the home both people have been registered with a local GP and their medical needs have been assessed. Both people had medical summaries in place, Health Action Plans have not been completed but the manager stated they plan to in the future. This becomes a recommendation of this report. We examined medication administration, both people’s files contained a document asking the person to give their consent for staff to administer their medication. Unfortunately in both cases neither of the forms were completed. This should be addressed. 1 person had a medication profile from the home where they lived previously and we questioned that usefulness of the document to anyone reading it now. Looking at peoples medication sheets showed that 1 person had a sheet printed by a pharmacist detailing the dosage and times that medication should be administered. It also showed that the medication had been audited when it entered the home. The other persons medication sheet was hand written, not signed by the author and there was no evidence of the medication being audited when it entered the home. This was brought to the attention of the manager and must be addressed in the future; failure to do this may put the person at unnecessary risk. It is a requirement of this report that all handwritten entries are signed by the person writing them and the quantity of medication is audited when it enters the home. It is also recommended that a list of sample staff signatures/initials are kept in the medication file. Medication was stored correctly in a metal cabinet fixed to the wall in the office which is locked when not in use. Ribston House DS0000072629.V378114.R01.S.doc Version 5.3 Page 17 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 People using the 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 has a complaints procedure and people living in the home feel confident that they can make a complaint if they are unhappy. Risk assessments and guidelines are not in place to support staff when managing potential risks. Records of financial expenditure are thorough and accurate minimising the potential risk to people in the home. EVIDENCE: The home has a complaints procedure and when speaking with 1 person they were able to explain to us what steps they would take if they were unhappy and wished to complain. The person we spoke with said that they would be able to complain if they were unhappy. In the hallway of the home there is a copy of the complaints procedure produced in an easy read format. No complaints had been made to the manager or the CQC since the home had been open. The home uses a “traffic light system” to manage peoples behaviour when it becomes challenging. We examined records for the time the home has been open and this showed that 2 incidents have taken place. Examining both incidents raised some concerns for us. Firstly we feel that an incident may Ribston House DS0000072629.V378114.R01.S.doc Version 5.3 Page 18 have occurred due to staff speaking to a person about a personal issue in a public space, and the second incident was where someone was physically aggressive towards staff but no risk assessments, or guidelines for staff were created as a result. Both incidents were brought to the attention of the manager. They agreed that a risk assessment should have been completed. This becomes a recommendation of this report. At the time of this site visit 1 person was responsible for keeping their own money, whilst the home kept the other person’s money. We examined the records of income and expenditure for that person which showed that they were correct at the time of this visit. Ribston House DS0000072629.V378114.R01.S.doc Version 5.3 Page 19 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 29, 30 People using the 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 property is newly built to meet the needs of people with physical disabilities and provides people with a spacious well-decorated environment that meets their current needs. EVIDENCE: The building is purpose built to meet the needs of people with physical disabilities. The accommodation is over 2 floors with bedrooms, bathrooms, toilets, lounges and dining rooms being provided on both floors. As well as the staircase there is also a lift to enable people to access both floors. Ribston House DS0000072629.V378114.R01.S.doc Version 5.3 Page 20 At the time of this site visit all of the rooms we saw were decorated to a good standard and the manager stated that as new people are admitted to the home it will be decorated to meet their tastes and wishes. The person we spoke with stated that they thought the house was nice. Throughout the home there are specialist adaptations in place to meet the potential physical needs of people that may move into the home. At the time of this site visit the home was clean and tidy with no offensive odours. Ribston House DS0000072629.V378114.R01.S.doc Version 5.3 Page 21 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, 36 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are enough staff on duty at all times to meet the needs of the 2 people currently living in the home. There is a good mix of skills within the staff team to meet people’s needs and where shortfalls have been identified training has been organised to address them. The home’s recruitment records do not fully adhere to the regulations and this may put people living in the home at unnecessary risks. EVIDENCE: At present there are only 2 people living in the home and the staffing reflects this. The rota for the service shows that there are 2 staff on each shift (this was confirmed by staff), 1 person sleeps-in and there is also a waking night staff. Speaking with the manager and looking at the rota shows that they are at the home between 9 – 5 Monday to Friday. The manager stated that once Ribston House DS0000072629.V378114.R01.S.doc Version 5.3 Page 22 more people move into the home the staffing will increase to meet those needs. The majority of the staff team have been recruited from other homes in the organisation and they have a wide range of experiences of working with this client group. At the time of this visit the manager had only recruited 2 staff from outside the organisation. We examined the recruitment records for both of these staff which showed that on the whole the documents providing evidence that they are able to work in this environment were present. A shortfall found in both cases was the employment history. The regulations state that the employer must obtain “a full employment history, together with a satisfactory explanation for any gaps”. Both of the application forms we saw did not provide a full employment history. This was brought to the attention of the manager; it becomes a requirement of this report that all future applicants provide a full employment history. Speaking with staff they explained that they had received an induction to Ribston House when they started. This was not a “full” induction as they were already working for the organisation. The 2 new members of staff had induction packs in their files, examining them showed that the manager had signed to confirm that the first part of induction training (before starting at the home) had been completed. But further induction required after starting at the home had not been signed off by the manager. The manager must ensure that all new staff complete induction as required. All staff have been receiving weekly supervision sessions since the home has been open. This was confirmed by speaking to the manager and staff. To meet the needs of people in the home the manager and staff are completing dementia training. Other courses have been booked; moving and handling, epilepsy awareness, infection control, food safety, safeguarding vulnerable adults, health and safety and fire safety. All of these courses will be completed by January 2010. The manager explained that they have booked 1 of the team leaders on a leadership and management course, whilst another senior support worker will be completing a risk assessment course. The manager is in the process of collating certificates to evidence the staff training and we were able to examine the 1 completed so far. It is recommended that the manager makes every effort to ensure that training records are available for all staff without delay. 4 of the staff team have completed NVQ’s (National Vocational Qualification) in health and social care to a minimum of level 2, and team leaders have completed health and social care NVQ’s to level 4. Ribston House DS0000072629.V378114.R01.S.doc Version 5.3 Page 23 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 40, 42 People using the 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 service is being managed by an appropriately qualified and experienced person. There is no quality assurance procedure in place and considering the amount of time the service has been operating it is difficult to judge. The service has a range of policies and procedures that minimise the potential risk of the service delivery being inconsistent. Potential risks to health and safety are minimised through the various health and safety checks completed by staff. EVIDENCE: Ribston House DS0000072629.V378114.R01.S.doc Version 5.3 Page 24 The registered manager was present throughout this inspection site visit. As well as being the registered manager for the home he is also the general manager for the organisation. He explained that he plans to employ another person to become the manager as more people are admitted to the service. In the hallway of the home we found a copy of the registration and insurance certificates. The home does not have a quality assurance procedure in place. The manager explained that Regulation 26 (see notes below) visits will take place each month. It is important that the manager develops a quality assurance procedure and it becomes a requirement of this report that this is done. All of the policies and procedures required by these regulations are in place having been adapted from other homes in the organisation. The manager has selected a number of policies that they consider essential reading for staff and these have been placed in the kitchen. Staff are expected to read and sign a document confirming they have understood them. The home has a fire risk assessment in place and all of the fire equipment had been inspected by a qualified engineer on 14/08/09. There were a range of other documents providing evidence of staff completing regular checks of the equipment. Looking at the records available there were none for staff to test lighting, doors or complete fire drills. The manager said they had completed an evacuation with 1 person in the home. The manager must ensure that all of the fire safety checks are completed as required. This becomes a recommendation of this report. Other steps taken to minimise potential health and safety risks to people include:• • • Fridge and freezer temperatures are recorded daily. Hot water outlet temperatures are monitored. There is a list of jobs that the manager expects the day and night staff to complete to ensure that the home stays clean, tidy and hygienic. Regulation 26 visits: - Where a service provider is not in day to day charge of the service monthly unannounced visit musts be completed. The person completing the visit must interview people, examine a selection of records including any complaints and then write a report detailing their findings. Ribston House DS0000072629.V378114.R01.S.doc Version 5.3 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 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 2 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 X 32 3 33 2 34 2 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 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 2 2 2 X 3 X 1 3 X 2 X Version 5.3 Page 26 Ribston House DS0000072629.V378114.R01.S.doc N/a 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 YA6 Regulation 15 Requirement The manager must ensure that accurate care plans are developed and implemented for each person as they are admitted to the home. Failure to do this puts people at risk of their needs not being met consistently by staff. 2. YA9 13 (4) b, c The manager must ensure that risk assessments are completed assessing potential risks to people’s safety whilst going about their lives. Failure to do this potentially puts people at unnecessary risks. 3. YA18 12, 14, 15 The manager must ensure that care plans detailing people’s personal care needs require a greater level of detail to ensure people’s preferences and needs are met consistently by the staff. Failure to do this may mean that people’s dignity is compromised and their needs are not met. 27/11/09 13/11/09 Timescale for action 27/11/09 Ribston House DS0000072629.V378114.R01.S.doc Version 5.3 Page 27 4. YA20 13(2) The manager must ensure that where medication instructions are hand written that the author signs confirming the information is correct. Medication must also be checked when entering the home to ensure that it is the correct dosage and quantity. Failure to address these areas may put people at risk of medication errors that affect their well-being. 02/11/09 5. YA34 7, 9, 19. Schedule 2 The manager must ensure that when recruiting new staff they document the person’s full employment history and any gaps are explained. Failure to do this may put people in the home at unnecessary risks. 02/11/09 6. YA39 24 The manager must develop a quality assurance procedure for the home that puts the views of people in the home as central to the future development of the service. Failure to seek the views of people in the home about the quality of the service makes it impossible to develop the service to meet people’s needs effectively. 11/12/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Ribston House DS0000072629.V378114.R01.S.doc Version 5.3 Page 28 1. 2. 3. YA6 YA17 YA19 The manager should ensure that care plans are reviewed as planned. Appropriately qualified health professionals should be involved when making decisions about people’s nutrition. The manager should ensure that health actions plans are completed for all people when they are admitted to the home. The manager should ensure that the medication file contains a list of sample signatures/initials for people qualified to administer medication. The manager should ensure that where people may present behaviour that challenges that risk assessments are in place to minimise the potential risks. The manager should ensure that there are detailed records of the training completed by staff, including certificates to prove the training has been completed. The manager should ensure that staff complete all of the fire safety equipment checks required by the regulations and that these are recorded for inspection in the future. 4. YA20 5. YA23 6. YA33 7. YA42 Ribston House DS0000072629.V378114.R01.S.doc Version 5.3 Page 29 Care Quality Commission South West Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 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) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. Ribston House DS0000072629.V378114.R01.S.doc Version 5.3 Page 30 - 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!