Inspection on 25/07/05 for Ridge House

This inspection was carried out on 25th July 2005.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Ridge House 06/01/08

Ridge House 08/11/06

Ridge House 23/01/06

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Ridge House Church Street Morchard Bishop Crediton EX17 6PJ Lead Inspector Rachel Fleet Announced 25 July 2005 10:00hrs 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 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Ridge House D54 D06 S64221 Ridge House V240177 250705 stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Ridge House Address Church Street Morchard Bishop Crediton EX17 6PJ 01363 877335 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Ridge House Residential Home Limited Mrs Deborah Jane Bradford Care Home 15 Category(ies) of OP Old age (15) registration, with number of places Ridge House D54 D06 S64221 Ridge House V240177 250705 stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 28 February 2005 Brief Description of the Service: Ridge House is in the village of Morchard Bishop, next door to the parish church and across the road from the village school. It is a large detached house, with an extension to one side of the building. The home is registered to provide care for up to 15 older service users. All bedrooms are for single occupancy. Seven bedrooms have en-suite facilities. There is a comfortable lounge, a conservatory lounge area off the dining room, and some residents like to sit in the entrance hallway. There is a stair lift to the first floor. The home stands in easily accessible large mature grounds, with a long patio area overlooking the rear gardens and countryside beyond. Ridge House D54 D06 S64221 Ridge House V240177 250705 stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspector was at the Home for 6.25 hours on what was her first visit to the Home. There were 14 residents at the Home that day, and she met with nine of them, some of whom had returned CSCI comment cards. Six residents and six relatives/visitors returned comment cards, which were positive about the Home. This relatively high response rate is a credit to the Home and their relationship with those they provide a service to. The inspector also spoke with two care assistants and a kitchen staff (who was also employed as a part-time care assistant). Certain records were reviewed, and the inspector looked around the Home – visiting some residents in their own rooms, whilst others she met in the lounge. The owners made themselves fully available to the inspector for the day, which was greatly appreciated. The Bradfords have recently registered a Limited company with CSCI as the Registered Provider, but both remain fully involved in running the Home, on a daily basis. Comments from visitors included ‘Friendly staff…Caring attitude’ and ‘The care assistants are understanding of the needs of each member of the Home’. What the service does well: What has improved since the last inspection? All requirements and recommendations from the last inspection have been addressed: Care records now include a photograph of the resident and objectives for their care. A system is in place for regular formal supervision with each staff member, and the Home is working to achieve 50 of staff qualified to NVQ2 level. Water temperature checks are recorded in relation to monitoring risks from Legionella. Ridge House D54 D06 S64221 Ridge House V240177 250705 stage 4.doc Version 1.40 Page 6 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. Ridge House D54 D06 S64221 Ridge House V240177 250705 stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Ridge House D54 D06 S64221 Ridge House V240177 250705 stage 4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) Standard 3 was not fully assessed on this occasion. Standard 6 does not apply. EVIDENCE: Ridge House D54 D06 S64221 Ridge House V240177 250705 stage 4.doc Version 1.40 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 & 10 Care planning systems fully inform staff about residents’ needs. Health needs are well met, with good multidisciplinary involvement ensuring this is achieved. Management of medications is generally satisfactory, but is compromised by two aspects of practice so that residents’ wellbeing is not fully protected. Care is offered in such a way as to ensure residents’ privacy and dignity. EVIDENCE: Each resident had their needs set out in their care plan, including social needs and objectives for care, and their photo is now kept. Staff said they found the care plans useful. Residents said they were consulted about their care; some had also signed their care reviews, which were done regularly. Risk assessments for falling were carried out. GP, psychiatrist and district nurse support was evident from records. A resident with complex health needs felt these were well looked after and managed. One care plan included particular monitoring of nutritional needs. Medications are supplied weekly by a dispensary at the local Surgery, in mediwallets. No controlled drugs were in use, and no residents were selfmedicating. All staff have undertaken a distance-learning course on medication, under a local college, within the last year. Appropriate records were kept regarding receipt and administration or disposal of other medications. Ridge House D54 D06 S64221 Ridge House V240177 250705 stage 4.doc Version 1.40 Page 10 Medicines requiring cold storage were not kept separately form other items in the domestic fridge. Fridge temperature checks were being done. It is recommended that these be increased to minimum/maximum daily readings as well, because insulin is being stored at present. The Home’s Homely Remedies list was discussed. For example, it included medications prescribed by a GP for certain individuals, rather than just items bought over the counter and kept as stock for any resident to receive in certain circumstances. And accompanying instructions did not specify when (regarding time or number of doses) the GP should be informed that homely remedies had been given. A resident said staff respected their privacy; another said staff didn’t intrude on them. Ridge House D54 D06 S64221 Ridge House V240177 250705 stage 4.doc Version 1.40 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14 &15 Links with the local community, relatives or other visitors and the activities on offer support and enrich residents’ lives. Staff promote residents’ exercise of choice and control. Meals are good, offering choice and variety, whilst catering for individuals’ dietary needs and preferences. EVIDENCE: Residents said there was sufficient for them to do in the day, some being able to occupy themselves, others enjoying regular visitors. The local church fete had been held annually in the gardens of the Home until this year, when it was moved to a covered venue. One resident said they came and went as they pleased, but still felt cared for and part of the Home. Visitors’ comment cards were positive about their contact with the Home. Families’ involvement was recorded frequently in care records. Residents spoke very positively about the Bradfords, and their daily involvement at the Home. One resident commented that their questions were always answered. Although there are no residents’ meetings at present, they had regular opportunities to speak to the owners about any issues or suggestions. Staff were overheard giving explanations to residents before assisting them. Residents said the food was good, balanced, and that they had been consulted about menus. Alternative meals were provided for those who didn’t like the set meal. A list of individuals’ likes/dislikes was seen in the kitchen. The cook confirmed fresh local produce was used weekly. Ridge House D54 D06 S64221 Ridge House V240177 250705 stage 4.doc Version 1.40 Page 12 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 & 18 The Home has a satisfactory complaints system, with evidence that residents’ concerns are listened to and acted upon. Appropriate action has been taken to try to ensure residents are protected from abuse. EVIDENCE: Residents said they felt able to discuss any issues with the owners or other staff, with some adding that they did not have any reason to complain. Two spoke about regular checks done by the nightstaff, to check they were ok. Staff knew where the complaints procedure could be found if someone requested it. The Home’s record of complaints included the action taken to address the complaint. Comment cards indicated the respondents felt safe at the home. Residents spoken with described staff as ‘caring’. Mr Bradford and other staff confirmed they had had training on protection of vulnerable adults, the latter describing procedures to be followed should they ever witness abuse occurring. Department of Health and Devon County Council guidance were available. CSCI has not received any complaints about the Home in the time since the last inspection. Ridge House D54 D06 S64221 Ridge House V240177 250705 stage 4.doc Version 1.40 Page 13 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 & 26 The standard of the environment within and around this Home is very good, providing residents with an attractive, clean, safe and homely place to live. Residents are protected by the Home’s policies and procedures for infection control. EVIDENCE: The environment looked well maintained internally, as were the grounds around the Home. Residents were happy with their own accommodation. One resident said their room was ‘marvellous’ – it had views across the countryside. Bedrooms are personalised, with residents’ own belongings around them, and some have direct access to the garden patio. Several new items have been purchased for the Home – a washer/drier, for example. Aids were seen in toilets and bathrooms, promoting independence. There is a high standard of cleanliness. Washing machines had recommended programmes for disinfection of laundry. Staff were soon having updating on infection control, and said there was always a supply of disposable gloves and aprons. A related matter is included under Standard 38. Ridge House D54 D06 S64221 Ridge House V240177 250705 stage 4.doc Version 1.40 Page 14 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 & 30 Sufficient numbers of staff are employed to meet residents’ needs. There are good relationships between residents and staff, who clearly cared about the residents. Residents and staff would benefit further if there were more training related to individuals’ needs, such as those who have had a stroke. Residents benefit from and are protected by the Home’s rigorous recruitment practices, and an active approach to training and supervision. EVIDENCE: Residents commented on how caring the staff were, and appreciated that the Home was well managed. They and the staff felt staffing levels were sufficient, as was also indicated on all comment cards from visitors. One resident said staff stopped to chat. Staff in conversation with the inspector evidenced concern for residents’ wellbeing. Staff files sampled contained required information. Induction programmes were very comprehensive, including videos and questionnaires. Training opportunities were provided for staff and those wishing to undertake an NVQ2 in Care were supported to do so. Of 13 care staff, five staff had NVQ2 or NVQ3 in Care, and one was undertaking an NVQ2. Linking the training programme further to residents’ particular needs (those who had had a stroke, for example) would benefit the staff team and residents. One-to-one training was sometimes available to individual staff who assisted visiting district nurses attending to residents. Staff meetings were said to be useful; minutes were kept. Formal (recorded) staff supervision has been commenced. Ridge House D54 D06 S64221 Ridge House V240177 250705 stage 4.doc Version 1.40 Page 15 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 35 & 38 The Home’s practices generally safeguard residents’ financial interests. These would be more robust if receipts were kept for every expenditure from residents’ personal monies. Some systems are in place to ensure safe working practices and to promote the safety and health of residents. These could be improved, however, by seeking advice from relevant authorities about managing infection risks from laundry and aspects of fire procedures, and developing a fuller risk assessment (and management) plan for Legionella. EVIDENCE: Records were kept relating to residents’ personal monies held by the Home on their behalf, including any money received and any expenditure. Cash totals correlated with those on records. Individual receipts were available other than for chiropody and hairdressing, when the Home was given a single receipt for all those seen. Staff explained appropriate procedures for handling residents’ money (if they needed shopping, etc.). Ridge House D54 D06 S64221 Ridge House V240177 250705 stage 4.doc Version 1.40 Page 16 Staff confirmed they had had mandatory training (first aid, etc.) within the last year. They were able to explain the fire procedure. If fire alarms sounded, staff investigated the cause before ringing the fire brigade. The inspector recommends that the local fire authority be consulted about this practice. Fire extinguishers had been serviced recently. Accident records were monitored, with involvement of significant others as necessary to try to prevent falls. Infection control systems could be strengthened by the use of alginate bags so that staff do not have to soak and rinse laundry by hand. Temperature checks are being recorded with regard to monitoring risk of Legionella. Development and review of a fuller risk assessment was discussed, based on guidance from relevant authorities. Residents and staff said there were no issues with individuals’ accommodation in relation to their needs (no hazards, etc.), and none were observed during the inspection. Records requested were well organised and kept in secure storage when necessary. Kitchen equipment had been serviced recently. Mr Bradford confirmed that the oil-fuelled boiler was to be serviced in the next few weeks, having last been serviced in 2004. A hard wiring certificate was seen dated July 2005. Ridge House D54 D06 S64221 Ridge House V240177 250705 stage 4.doc Version 1.40 Page 17 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x x x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x x x 2 x x 2 Ridge House D54 D06 S64221 Ridge House V240177 250705 stage 4.doc Version 1.40 Page 18 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 9 Regulation 13(2) Requirement You must make arrangements a) to ensure that all prescribed medicines are stored safely, including items kept in a fridge which must be kept separately and securely from other nonmedication items, with minimum/maximum daily temperature readings advised when insulin is being stored; b) to ensure safe administration of medicines, by clarifying Homely remedies procedures. Timescale for action 17 09 05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 30 Good Practice Recommendations You should ensure staff are as fully trained & competent to do their job as possible, by including residents’ particular needs (relating to strokes, for example) in training programmes. You should obtain named receipts for each expenditure from residents personal monies held on their behalf by the Home. You should ensure the health & safety of residents & staff D54 D06 S64221 Ridge House V240177 250705 stage 4.doc Version 1.40 Page 19 2. 3. 35 38 Ridge House are as fully protected as possible by a) reviewing practices for dealing with soiled laundry, seeking specialist advice, to minimise cross-infection risks to staff; b) seeking advice from the local fire authority about whether staff should investigate the cause of fire alarms sounding before ringing the fire service, or not; and c) developing a fuller risk assessment plan for Legionella (and management strategies if necessary). 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