Inspection on 06/01/08 for Ridge House

This inspection was carried out on 6th January 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Ridge House 08/11/06

Ridge House 23/01/06

Ridge House 25/07/05

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 17/02/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Ridge House Ridge House Church Street Morchard Bishop Crediton Devon EX17 6PJ     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: Deirdre McEvoy     Date: 0 6 1 1 2 0 0 8 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. the things that people have said are important to them: They reflect 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 Older People 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 Older People Page 2 of 33 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.csci.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Ridge House Church Street Ridge House Morchard Bishop Crediton Devon EX17 6PJ 01363877335 01363877335 ridgehouse@fsmail.net Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Deborah Jane Bradford Type of registration: Number of places registered: Ridge House Residential Home Limited care home 15 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Ridge House is registered to provide personal care, but not 24-hour nursing care, for up to 15 residents over retirement age. It is run by Mr & Mrs Bradford, who work at the home in various roles (including care-giving)on an almost daily basis. Mrs Bradford is registered with the Commission for Social Care Inspection (CSCI) as manager. The home is in the village of Morchard Bishop, next door to the parish church and opposite the village school. It is an older, large detached house, with a more recent extension. All bedrooms are for single occupancy, and seven have en-suite facilities. Two are accessed by a small flight of steps, and careful assessment of mobility is made with prospective residents before any are given these bedrooms. There is a lounge, a conservatory lounge area off the dining room, and a sitting area in the entrance Care Homes for Older People Page 4 of 33 0 Over 65 15 Brief description of the care home hallway - which also has a staircase and stair lift to the first floor. The home has accessible, mature grounds, with a long patio overlooking the rear gardens and countryside beyond. There is parking space at the front of the home. Weekly fees at the time of the inspection were 400 pounds- 525 pounds. These did not include the costs of chiropody, hairdressing, toiletries, newspapers or magazines, some transport costs, private phone lines, and continence aids other than any provided through local health services - which are at cost price. Inspection reports produced by the Commission for Social Care Inspection (CSCI) about the home are available on request from the owners, or the person otherwise in charge at the time. Care Homes for Older People Page 5 of 33 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 Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: As part of this key inspection the manager completed an Annual Quality Assurance Assessment (AQAA), which contained general information about the home, and an assessment of what they do well and what they plan to improve upon. Before our visit to Ridge House we sent a number of confidential surveys to people living there, to staff and outside professionals to hear their views. We received completed surveys from 5 people living at the home and from 8 staff. The comments and responses we received have helped us to form the judgments we have reached in this report. We (The Commission) spent just over 9 hours at the service. There were 14 people Care Homes for Older People Page 6 of 33 living at the home at the time of our visit. To help us understand the experiences of people living at this home, we looked closely at the care planned and delivered to 4 people. Most people living at the home were seen or spoken with during the course of our visit and we spoke with 5 people in depth to hear about their experience of living at the home. We also spoke with 2 relatives, 2 visiting health professionals and 4 members of staff, including the manager. We looked around the home and checked records, such as, care files, medication records, staff recruitment and training records, quality assurance records, and some safety records. We completed an Annual Service Review of the home on 31st March 2008, which indicated that the home was still providing a good service to people. Copies of this report can be obtained from CSCI. What the care home does well: What has improved since the last inspection? Care Homes for Older People Page 8 of 33 Aspects of the management of peoples medication have improved. The home is now recording why prescribed medication has not been take. The home also keeps a record of what medication is received and disposed of, including if returned to the pharmacy in compliance aids. Staff have received training relating to conditions associated with old age, which ensures that staff fulfil the aims of the home and meet the changing needs of the people living there. The home has consulted with people about the types of activities they would like so that a meaningful activity programme can be offered. General improvements were seen to the environment, new furniture had been purchased for two bedrooms and the garden 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 Care Homes for Older People Page 9 of 33 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.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 10 of 33 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 33 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 and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. 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 them 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information about this service is shared with people prior to their admission so that they know what to expect. The assessment process ensures that the home can meet peoples needs. Evidence: The home has written information about the services it provides. People responding to CSCI surveys told us they had received enough information about the home before moving in. People also told us they had received contracts relating to their stay at the home, which helps to protect their rights. We looked at the assessment for the most recently admitted person to help us judge how the home assesses peoples needs to ensure they can be met. The manager told us she always visits people to carry out an assessment before any decision to move in is reached. As well as completing a pre-admission assessment of needs, the home Care Homes for Older People Page 12 of 33 Evidence: gathers a range of information from family members and professionals involved. The homes assessment covers most of the areas of need and includes people preferences. People considering a move to the home and their relatives are given the opportunity to visit to assess the quality, facilities and suitability of Ridge House. One relative told us, Debbie & John were very careful to ensure my father would be comfortable, safe and secure in their care, and took time to understand my fathers very unusual situation & state of health before he moved in. The home does not provide intermediate care. Care Homes for Older People Page 13 of 33 Health and personal care 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 health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they 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. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them 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. People are looked after well in relation to their health and personal care needs. Staff respect peoples privacy and promote dignity. However, care plans and risk assessments do not always reflect the high standard of care delivered. The systems in place for the management of medication need attention to ensure medication is handled safely. Evidence: We talked to people about the care they received and whether it was suited to their needs. People told us they always receive the care and support they need. One person told us, We couldnt wish for anything better, another said, They are looking after me very well. Visitors were also happy with the care and support given to their relatives. One told us the care and support was above and beyond what was expected. Another visitor described the improvements to their relatives health since moving to Ridge House adding, She has the best care here. Care Homes for Older People Page 14 of 33 Evidence: We looked at how the home plans and delivers care by looking at four peoples care plans. Care plans contain some details about peoples likes and dislikes and some information about their preferred routine. However, there is a lack of specific detail, which could result in peoples needs not being fully understood or met by all staff. For example, daily notes are not kept but significant events are recorded. The notes for one person show that they had developed an open sore on their buttock. The next entry in the care notes was 11 days later and just said Dressing came off. No dressing here to re-apply. There was nothing in the notes or care plan to indicate how this sore had developed or the action staff were taking to deal with the sore and reduce a reoccurrence. There was no evaluation of the treatment given to show whether it had been effective. We were told by the manager that the sore had healed but there was no evidence of this is in the care plan or care notes. The home was using an assessment and Social Services care plan to direct the care for another person rather than developing a care plan once the person had been admitted. The information in the Social Services care plan did not give specific instructions to staff about the actual care needed. This person had depression and short-term memory loss but there was no information about how this may affect them or the steps to take to monitor and respond to any problems, which may arise as a result. Care plans also lacked information about how peoples social, emotional and spiritual needs are to be met (Refer to standard 12). Staff told us they always or usually have up to date information about peoples needs. They described the systems in place for ensuring that relevant information is shared with staff, such as, a hand over for each shift and a communication book which contained information about any changes to peoples needs. Staff spoken with demonstrated a good knowledge of the peoples needs and personalities. The manager was extremely well informed as to the history, characteristics and needs of the people living at the home. However, two staff did say that information is not always passed to them, for example when people are unwell or when they are prescribed new medication, such as antibiotics. Having vital information in care plans will ensure all staff are aware of changes and what is expected of them. In spite of the lack of information in care plans, peoples care needs appeared to be met by the knowledgeable and experienced staff and manager. People told us (via surveys) that they always or usually received the medical support they need. Care files show that people receive good support from relevant health care professionals including G.P, district nurse, and chiropodist, which helps to ensure their health needs are met. People are also supported to attend Hospital Care Homes for Older People Page 15 of 33 Evidence: appointments. One relative told us the home often took their relative to hospital appointments, which was much appreciated. One relative commented about the care their relative received by saying that the home had, Given him back a little of his life and helped him recover as much as possible when everyone else pretty much gave up on him. We met with two visiting health professionals during this inspection. Both were completely happy with the care provided at the home. One told us, We are always contacted appropriately. The nurse told us that one persons pressure sore healed well and this was an indication of the quality of care at the home. Community nurses told us peoples personal care was well attended to and that frail people appeared to be well nourished and hydrated. Visiting professionals were confident that staff followed their instructions. One told us, We have no concerns about this home. They work well with us. Another told us, Staff are aware of what is going on for each person and the manager is very knowledgeable. Other comments from health professionals include, The standard of care here is pretty good, and Nothing is too much trouble for the staff. The team are brilliant. We saw that pressure-relieving equipment, such as mattresses are used to protect frailer people from developing pressure sores. Nutritional assessments are not routinely completed for people to ensure that these needs are met, but regular weights are kept for some people. Those looked at show that people either maintain or steadily gain weight following admission. One person cared for in bed was observed throughout the day; it was evident that staff visited this person regularly offering care and ensuring that diet and fluids were taken. This person appeared to be comfortable and warm and reacted positively when attended to by staff. The management of peoples medication was looked at; No one living at the home was managing their own medication. Medication is dispensed from the local surgery weekly. Medicines are delivered in individual compliance aids for each person. We found that one controlled medicine was also dispensed this way and not stored securely according to regulation. The home does not currently have appropriate storage for Controlled Drugs (CDs). We also found that records of CDs were not kept correctly. This was discussed with the manager at the time of our visit and she was advised about the correct storage and how the use of CDs should be recorded. Following the inspection the manager contacted us to tell us the correct medicines cabinet had been ordered. Medication administration records (MAR) showed that people receive the medication they are prescribed. Some medication is prescribed with a variable dose but the actual dose given is not recorded, as is good practice. We saw that all MAR charts are hand Care Homes for Older People Page 16 of 33 Evidence: written but not checked and signed by two people to ensure accuracy and accountability as is good practice. The home is now keeping a record of medication received and medication returned to the pharmacy as recommended at the last inspection. During our visit we saw that staff approached people in a respectful and friendly way. Staff were seen to knock on peoples doors before entering private bedrooms and we heard staff addressing people politely. People told us that staff were always respectful towards them. One person told us, Staff couldnt be more discreet, they are wonderful. Another person told us, Staff treat me very well. One person wrote in their survey, The members of staff have become my very good friends, who never presume in any way and we have a in this sense, a nice relationship. One visitor told us that staff ensured their relative was always dressed nicely and that staff were careful to make sure she is dressed before visitors are allowed into her room. Health professionals told us they could see people in the privacy of their own bedrooms. Care Homes for Older People Page 17 of 33 Daily life and social activities 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 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. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. 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. Activities provided currently suit peoples interests and abilities. People are supported to make choices and to be as independent as possible. There is a relaxed atmosphere where visitors are welcomed, and peoples individual dietary needs and preferences are catered for. Evidence: People told us the routines within the home were flexible and suited their needs. Comments included, I like to be up early and this is never a problems for staff. We have created our own routine and You can do what you want to here. Staff were seen to provide care and support in an unhurried way and to go at the pace of each individual. People told us there were always or usually activities they could take part in at the home. These include games, such as bingo, quizzes, scrabble and dominos. People told us about the other activities they enjoyed such as an exercise session and occasional visits to the local pub. Two women told us they also enjoyed the manicures staff give. A monthly communion is held at the home. We were told that various Chaplains visits some people at the home, which provides them with an opportunity to Care Homes for Older People Page 18 of 33 Evidence: have their religious and spiritual needs met. One person fairly new to the home expressed a wish to attend church and wasnt aware that a monthly communion was held at the home. This information was not in the care plan to ensure that this persons wishes could be met. Mrs Bradford told us that everyone living at the home is always invited to attend the communion, but that some people would be unable to remember whether they had attended or not. During our visit people were seen to be engaged in their chosen activity, some people were reading or chatting with others, visitors and staff, some were watching their favourite programme on TV. People also said they could enjoy the lovely gardens during the better weather. Staff told us they have opportunities to spend one to one time with people, reading to or with them and giving manicures and hand massage. Generally people were happy with the level of activity provided, however one person fairly new to the home was not aware of any specific activities within the home. Two people told us they did not want to be involved in organised activities and preferred to spend time in their room, which was respected by staff. Visitors are welcome at the home and people told us they could see their visitors when it suited them. We spoke with three people visiting the home during this inspection. All said they were welcomed by staff and always offered refreshments. One relative told us, I can come at any time. They are all very friendly here. There is a nice relaxed atmosphere. Another visitor told us, I have been visiting this home for several years. We always get a nice reception from staff. People can choose where to spend time with their visitors, either in the privacy of their bedroom or one of the communal spaces. Relatives told us that the home keeps them informed of any significant changes affecting their relative, one told us, They are good at keeping in touch with us. People told us that staff always listen and act on what they say, which promotes choice and independence. During our visit we observed that staff responded to people requests in a friendly and timely way. Most people could choose where they spent their day. We saw that peoples bedrooms had been personalised with pieces of furniture, pictures and photos brought from home. The home does not act as appointee for any one, leaving people free to choose who assists them with their financial affairs. The majority of people responding to our survey said they always like the food at the home; one person said this was sometimes the case. Several people made positive comments about the food during our visit. People told us, The food is very good. The pastry is out of this world!, We have the best of food, The food is always very good and I am very happy with the menu. People told us they could have an alternative if they didnt want the main meal, one person said, They asked us all Care Homes for Older People Page 19 of 33 Evidence: about our favourite things and then put them on the menu. Lunchtime was an unhurried and sociable occasion. The tables were nicely set, with napkins and condiments. Staff were on hand to assist where needed. Care Homes for Older People Page 20 of 33 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. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. 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 has a satisfactory complaints system, with evidence that people feel their concerns or complaints would be listened to and acted on. People are protected from abuse by well-informed staff. Evidence: Everyone returning our survey said they knew who to speak with should they be unhappy about anything. Although most people also knew how to make a complaint, two people told us they did not. A copy of the complaints procedure is available for people to look at. Everyone spoken with during our visit said they would speak with the manager or a member of staff if they had any concerns. One person told us, I have no complaints at all, I have every confidence in all of them. Another person said, I would just speak with the staff. One relative told us the were particularly impressed with how the manager and staff listen to peoples concerns, they wrote, Debbie & John are prepared to talk things through and They are very kind and understanding. The home and the Commission have received one complaint since the last inspection. The manager responded to this complaint within the agreed timescales. People told us they were well cared for and that they felt safe at the home. One person said, All the staff are very good. We are all friend together here. Another person said, Staff treat us very well indeed. Staff spoken with had attended training in order Care Homes for Older People Page 21 of 33 Evidence: to ensure people are safeguarded from abuse. Staff spoken with had a good understanding of what to do should they suspect poor practice or abuse of any kind. Staff were aware of the organisations outside of the home to contact should they have any concerns. This helps to protect people. We saw that new members of staff had been booked on safeguarding training for December. Care Homes for Older People Page 22 of 33 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, 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. 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 has been decorated and maintained to a good standard. All areas are clean, comfortable and homely, although attention is needed to ensure the home is safe throughout. Evidence: A tour of the premises included all communal areas, some private bedrooms and communal bathrooms, the kitchen and laundry area. People spoken with during the inspection were happy with the communal areas and their own private bedrooms. One person told us, One of the great things about this place is the view. Another person told us, I like the setting here and another said, My room is particularly nice. People are encouraged to bring items of furniture, pictures and personal belongings to make their rooms feel homely and personalised. The garden is accessible and attractive, providing pleasant areas for people to sit or stroll. The AQAA shows that maintenance and refurbishment of the home is on-going, which ensures a pleasant environment. The home is planning to improve the bathroom facilities. The majority of people currently use one bathroom, with an assisted bath, on the ground floor. We were told that the bathroom on the first floor is rarely used and the owners are planning to consult with people and review individual needs with a view to installing a shower Care Homes for Older People Page 23 of 33 Evidence: room on the first floor. There are aids and some adaptations to assist people with mobility and promote independence; for example, there is a stair lift between the ground and first floors. We saw raised toilet seats and wash stools, a bath with a hoist and ramp access to the patio/garden. People have access to call bells in their room although one person could not reach the call bell from their chair. We were told, I call or bang. They (staff) are about quite often. The manager told us and one visitor confirmed that staff visit people in their room regularly. We were told that windows on the first floor had been fitted with window restrictors to prevent people falling out accidentally. However we found two first floor windows, which were not restricted, posing a risk. This was reported to the manager, who assured us this would be attended to at the end of the inspection. Following the inspection the manager confirmed with us that windows had been made safe. Most radiators have either been covered or large items of furniture are in front of them to reduce the risk of burns or scalds. However some radiators in hallways and communal areas, e.g. the dining room, are not covered and could pose a risk to people. The manager contacted us following the inspection to tell us the radiator in the dining room had been covered to reduce the risk and that the radiators in the hallway were kept at a low surface heat. Hot water temperatures are controlled by thermostatic valves to prevent the risk of scalding. The home was clean and fresh throughout on the day of our visit. People told us (including via surveys) the home was always clean and fresh. One person told us, The home is always spotless. The home has good supplies of disposable gloves and aprons and staff have received training on good hygiene practice to promote good infection control. The laundry was clean and well organised and had the necessary equipment. People told us they were happy with the laundry service at the home, one person said, I am very happy with this service. Nothing is lost or ruined. Care Homes for Older People Page 24 of 33 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 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 to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. 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. There are sufficient numbers of staff on duty with appropriate skills and knowledge to meet the needs of the people living at the home. Recruitment practices are not robust. Evidence: People spoke highly of the staff team saying, Staff are very good, Staff are all very friendly and Staff are wonderful. People told us that staff were always available when needed, one person said, When I ring for help they come quickly, another person told us, They (staff) are always around when you need them. Although busy, staff were seen engaging with people throughout the inspection and assisting them as necessary. There are a minimum of two care staff on duty throughout the day, supported by a part time cook and cleaner. The owners also provide considerable daily support, Mrs Bradford is the registered manager and provides hands on care whenever necessary. Six staff told us there were always enough staff on duty to meet peoples needs; two felt this was usually the case. We noted that the staff rota did not record the hours the registered manager worked at the home; a recommendation has been made to ensure that the staff rota accurately reflects the staff on duty at any time. Since the last inspection the sleep-in cover arrangements at the home have changed. Care Homes for Older People Page 25 of 33 Evidence: There is one waking night staff on duty with Mr & Mrs Bradford providing on-call support from their home in the grounds of Ridge House. Good systems have been set up to ensure staff can contact Mr & Mrs Bradford when needed. People told us staff were available at night when needed. The AQAA shows that none of the people currently living at the home require the support of two care staff at night. A recent fire safety inspection by Devon & Somerset Fire & Rescue Service found satisfactory standards of fire safety, including the arrangements for night staff. Staff spoken with were clear about their role and responsibilities. Staff appeared to be motivated and enjoyed their work. Staff told us, I would like to say that Ridge House is one of the best homes that I have worked in. The management and staff are all dedicated to the service users. Another member of staff wrote, I think on the whole it is quite a happy place to work. There is a strong commitment to enable staff to achieve a nationally recognised care qualification (NVQ training). The AQAA shows that nearly 70 of staff have achieved NVQ 2 or 3. This is to be commended and helps to ensure good general standards of care within the home. Staff contacted by us said they had received an induction training, which helped them to understand how to work safely and respectfully with people. We looked at the induction record of the most recently employed member of staff, which showed that a written induction programme for new staff had been completed. Since the last inspection staff have received training about conditions, which affect older people, such as strokes and Parkinsons Disease. Staff told us they found these sessions valuable. One staff member wrote, We are all given the chance to attend training, we all enjoy the different courses, it helps us to understand their needs. Staff told us they always or usually have the right experience and knowledge to support people. One member of staff told us they would like More in house and outside training. We looked at the records of two staff who have been recruited since the last inspection. Records showed that both new staff had started working at the home before all checks had been completed, for example, Criminal Records Bureau checks (CRB & POVA) and references were not received until after their start date. This is an outstanding requirement from the previous inspection and this practice is potentially unsafe. Mrs Bradford assured us that both staff worked only under close supervision until all checks were received and found to be satisfactory. Care Homes for Older People Page 26 of 33 Care Homes for Older People Page 27 of 33 Management and administration 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 led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate 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. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. 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 is well managed, with systems in place to ensure that peoples views are sought and acted upon. Satisfactory systems are in place to promote the safety and welfare of people living and working at the home. Evidence: Mrs Bradford has owned and managed the home for several years. She has the necessary experience, skills and qualifications to do her job effectively. She is very hands on in her approach, ensuring she is well known to all people living at the home and her staff. She provides clear leadership, guidance and support to staff to ensure peoples needs are met. People expressed their confidence in the management of the home, one person told us, I have every confidence in all of them. One relative told us, Debbie runs a nice tight ship!, another relative wrote, Ridge House is a residential home of the very highest calibre in all respects. Visiting health professionals told us, They are well Care Homes for Older People Page 28 of 33 Evidence: organised here and I never have a concern or complaint about this home. Debbie and the staff are brilliant. People living at the home, their relatives, staff and other visitors described the home as a friendly place. The home has a quality assurance system, which enables people living at the home, their relatives and professionals to have their say about how well the home is performing and what improvements could be considered. Surveys on different aspects of home-life are carried out at least yearly, most recently activities provided within the home have been reviewed and people have been asked for their suggestions to improve this area. We saw the outcome of an annual survey completed earlier this year, which showed very positive responses from people and high satisfaction rates. The home will administer small amounts of personal monies. A secure system is in place to ensure people are protected, including individually kept accounts and cash balances and two signatures obtained for each transaction. Two accounts was checked and tallied correctly. We looked at the way that the home ensures that people are safe. We found that staff have received training on health and safety topics, including fire safety, moving and handling and infection control. Two staff told us they were waiting for first aid updates, which the manager said was being organised. The AQAA shows that 12 of the 15 staff employed at the home have received food hygiene training to ensure good standards in this area. The AQAA also shows that policies and procedures are in place on health and safety topics to guide staff with safe practice. Accidents and incidents are recorded; Accident forms are completed if someone sustains an injury and records of falls without injury were seen in care notes. The AQAA showed maintenance of equipment, water, electrical and gas systems was upto-date. A visit by a fire safety officer found satisfactory standards of fire safety in August 2008. Care Homes for Older People Page 29 of 33 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 29 19 The registered person shall 31/12/2006 not employ a person to work at the care home unless (a) the person is fit to work at the care home. (b) subject to paragraphs (6) (8) and (9), he/she has obtained in respect of that person the information and documents specified in paragraphs 1 to 9 of Schedule 2. This is especially regarding timely police checks, such as the POVA first check, & evidencing that gaps in employment history have been explored. Care Homes for Older People Page 30 of 33 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 9 13 You must review the arrangements for storing controlled drugs. This is to ensure that such medicines received into the home are securely stored and comply with current legislation. 31/01/2009 2 29 19 You must ensure that you 31/01/2009 operate a robust recruitment procedure. This will ensure that people living at the home are protected from unsuitable staff. 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 7 It is recommended that care plans set out in detail the action which needs to be taken by care staff to ensure that all aspects of the health, personal and social care needs of people are met. It is recommended that handwritten MAR entries be signed Page 31 of 33 2 9 Care Homes for Older People by two competent people to ensure accuracy and accountability. You should ensure that the actual dose given is recorded where medicines are prescribed as variable doses. 3 12 You should ensure that people have an opportunity to attend church, where possible, so that their spiritual needs can be met. It is recommended that a risk assessment be completed to ensure that uncovered radiators do not pose a risk to people. To ensure accurate records are kept, it is recommended that the staff rota accurately reflect which staff are on duty at any time including the hours worked by the manager. 4 25 5 27 Care Homes for Older People Page 32 of 33 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. 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