Inspection on 20/06/07 for Ridgecourt Residential Care Home

This inspection was carried out on 20th June 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

Ridgecourt Residential Care Home 27/04/06

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 Ridgecourt Residential Care Home Ridgecourt Bridgetown Hill Totnes Devon TQ9 5BH Lead Inspector Judy Cooper Unannounced Inspection 20th June 2007 9:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Ridgecourt Residential Care Home DS0000066672.V337476.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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. Ridgecourt Residential Care Home DS0000066672.V337476.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ridgecourt Residential Care Home Address Ridgecourt Bridgetown Hill Totnes Devon TQ9 5BH 01803 866152 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) Ogwell Grange Ltd Mrs Irene Jennifer Wilson-Tancock Care Home 15 Category(ies) of Old age, not falling within any other category registration, with number (15) of places Ridgecourt Residential Care Home DS0000066672.V337476.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 24/04/06 Brief Description of the Service: Ridgecourt is a detached period property, set in its own grounds at the top of Bridgetown Hill in the South Hams town of Totnes. The home provides six single and one double bedroom on the ground floor, and eight rooms on the first floor. The ground floor has two communal lounges (one incorporating a sun lounge facility), a dining room and all necessary service areas i.e. kitchen, laundry room etc. Residents at the home benefit from having easy access, from the front of the home, to the home’s level gardens and the recent improvement of a ramp, leading from the sun lounge to the front garden, has also further enhanced accessibility to those with any mobility problems. There is plenty of open parking to the front of the home. The current weekly fees range from £370 to £472.00. The inspection report is contained within the home’s statement of purpose and home’s service user guide, which is available immediately on entering the home, being sited in the communal hallway. Ridgecourt Residential Care Home DS0000066672.V337476.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This site visit took place on Wednesday 20th June between 9.30a.m and 4.30 p.m. Opportunity was taken to look at the general overall care given to all residents. The care provided for two residents was also followed in specific detail, from the time they were admitted to the home, which involved checking that all elements of their identified care needs were being met appropriately. A tour the premises, examination of some records and policies, discussions with the manager, residents and staff, as well as one visitor to the home, also formed part of this inspection, whilst staff on duty were observed, in the course of undertaking their daily duties. Other information about the home, including the receipt of eight completed questionnaires from residents, ten from relatives, one from a visiting G.P. and seven from staff members at the home, has also provided information as to how the home performs, and all of this collated information has been used in the writing of this report. All required core standards were inspected during the course of this inspection. What the service does well: The homes’ detailed information, available prior to admission, and the home’s in depth admission policies ensures that prospective residents are fully aware of what services the home can provide prior to admission. This allows them to be able to move into the home confidently knowing the staff will be able to meet their needs. All residents strongly stated that their basic rights, such as dignity, respect and privacy are always and fully upheld by all those involved in their care. All residents stated that they received very varied, nutritious meals prepared to an excellent standard and that they always looked forward to and enjoyed their meals at the home. Visitors are welcomed and encouraged to the home and relatives, who provided formation about the home, confirmed this saying that staff went out of their way to make them feel welcomed at any time. Ridgecourt Residential Care Home DS0000066672.V337476.R01.S.doc Version 5.2 Page 6 Ridgecourt provides a comfortable, secure, well maintained environment, where residents’ individuality is encouraged and upheld and where residents are freely able to choose how they spend their time. Residents spoken to confirmed that their opinions are always sought and acted upon and that they felt very comfortable and well cared for within the home. The management of the home remains strong and professional with the very experienced manager having now been in post for a number of years. All spoken to praised the manager and residents stated that they would be easily able to approach her for support and advice and had confidence in her to ensure that their care was maintained to the best possible standard. What has improved since the last inspection? The home has updated its statement of purpose and service users’ guide and all residents now have a contract with the registered provider who took over ownership of the home approximately 18 months ago. The introduction of new specialised cleaning products has further helped minimise the risk of cross infection within the home and therefore helps protect residents as much as possible. The upgrading of an existing ramp from the front of the home to the front garden has improved access for all residents as well as those who may need a wheelchair. All trees surrounding the property have been risk assessed by a qualified tree specialist to ensure resident safety remains paramount. Staff training has been increased to include both statutory training and increased access to National Vocational training in care. This helps ensure that staff who attend this training are fully aware and able to meet the residents’ needs. The employment of a regular maintenance person has helped the home be able to maintain a good environment for the residents by allowing the manager to respond quickly to any maintenance fault noted and by the maintenance person routinely undertaking general upgrading works within the home. The home’s registered manager has now completed the NVQ level 4 in care award to complement her Registered Manager’s award. This ensures she has the necessary level of training to be able to manage the home as effectively as possible. Ridgecourt Residential Care Home DS0000066672.V337476.R01.S.doc Version 5.2 Page 7 What they could do better: The home’s medication systems should be further enhanced to include a picture of each resident on their individual medication records as well as maintaining a signatory list of all staff that administer medication. This is to ensure that the administration of medication is undertaken in the safest manner to ensure that residents remain best protected. The registered manager should seek out residents’ views regarding the provision of a more regular planned activity programme, rather than continuing with the informal arrangements that currently exist. This is so that residents would be able to know what activity is planned on what day and could then decide whether or not they wished to take part. Staffing should then be made available to allow the provision of any such activity programme. (Following this inspection the registered manager confirmed that she had already offered three regular weekly activities and was arranging a residents’ meeting to further discuss what other options the residents may like). The registered manager must always maintain residents’ protection by ensuring that all staff working within the home are suitably vetted and have had up to date checks carried out, including an enhanced Criminal Record Bureau check, to ensure that they are suitable to work with potentially vulnerable people. (Following this inspection the registered manager confirmed that requests for all required recruitment checks had now been undertaken). All staff designated to work at the home should also undergo the home’s induction course to ensure that each new staff member is aware of the how to deliver care appropriately and within the home’s agreed code of conduct. This is to ensure that all residents remain cared for by a suitably trained staff group. The registered manager should review the current number of allocated staff hours within the home to ensure that residents’ social, as well as personal care needs can be met as required. The registered manager should ensure that all the staff attend the regularly provided statutory training such as the protection of vulnerable adults, first aid, fire awareness etc. This is so that all staff involved in the care of the residents remain aware of the best ways to protect residents. (Following this inspection the registered manager confirmed that steps were being taken to ensure that all staff working at the home attended the required training that is already made available). Please contact the provider for advice of actions taken in response to this Ridgecourt Residential Care Home DS0000066672.V337476.R01.S.doc Version 5.2 Page 8 inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Ridgecourt Residential Care Home DS0000066672.V337476.R01.S.doc Version 5.2 Page 9 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 Outcomes Statutory Requirements Identified During the Inspection Ridgecourt Residential Care Home DS0000066672.V337476.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 (6 is not applicable). Quality in this outcome area is good. The admission process is thorough and well managed with prospective residents being made aware, prior to admission, that the staff at the home can meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home’s service user guide and statement of purpose has been recently further upgraded and now provides very comprehensive and relevant information which is useful to prospective and existing residents as well as their families and/or carers. The last two years of inspection reports are also included in this documentation, as well as the most recent one, to allow all to see how the home is building on its strengths and addressing any identified weaknesses. Details of advocacy agencies available to help those in care, the philosophy and contact details of the General Social Care Council and other useful information and contact details from such agencies as Help the Aged are also contained with the service user’s guide. Ridgecourt Residential Care Home DS0000066672.V337476.R01.S.doc Version 5.2 Page 11 This ensures that residents and/or their families are able to access this information easily. Since the last inspection the home has admitted some new residents. One new resident was talked with during the inspection and another, who had recently returned back to the home following a move to another area of the country, was also spoken with. Both were able to confirm that their admissions had been undertaken in such a manner as to allow them to be aware of what services the home could offer (in respect of the resident that returned back she confirmed she had been made aware that her old room was not available but was given information about which new room she would be able to occupy and then chose to take it and return). It was particularly pleasing to note that the same resident had also benefited from a new thorough and detailed pre-admission procedure which ensured the staff were aware of any newly presenting needs that had may have arisen since the resident had last been in the home. This also allowed the resident to be confident that the staff at the home were aware of these needs and would once again provide the necessary care needed. The manager stated that the home will try and offer a trail period of at least a month if requested and all prospective residents and/or their families/carers are given the home’s statement of purpose and service user’s guide prior to admission. All needs are assessed prior to admission and the manager visits prospective residents at their current address whilst they and their families are also invited to visit the home for a meal or a coffee to meet the staff, other residents and have a look around. Up to date contracts, which contained the name of the current registered provider, were in place for the residents and a resident’s feedback form stated that he had been given a new contract to reflect the new ownership. This shows that residents are aware of the change of ownership and of the contractual rights and expectations that exist with the registered provider. Feedback comments from residents regarding their admission process also included: “I came to live at home after a week of respite care which was a helpful experience”. “ I had no doubt about moving to Ridgecourt, it was the right choice and I have no regrets. The atmosphere is a happy and relaxed one. I have never heard discord only lots of laughter”. The home now has a new website which can be found at: www.OgwellGrange.co.uk The home does not provide an intermediate care service. Ridgecourt Residential Care Home DS0000066672.V337476.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 The quality in this outcome area is good. All residents are looked after well in respect of their health and personal care needs and their privacy and dignity upheld whilst their life style choices are fully respected. Some small additional measures need to be put in place to fully ensure residents’ medication is administered as safely as possible. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care plans were seen in respect of the two residents who were case tracked. These were thorough and covered all required care needs as well as social and psychological needs. Those seen evidenced that residents are fully involved in both the drawing up of the care plan and in the monthly reviews of the plan. The residents’ health care needs were being fully met, including any specialist needs. Any new presenting needs are fully reviewed by the manager i.e. increases in falls, continence needs etc and an analysis undertaken to ensure the most appropriate care is provided. Ridgecourt Residential Care Home DS0000066672.V337476.R01.S.doc Version 5.2 Page 13 As well as using care planning effectively the home has also been involved with using the Liverpool care pathway (used three times this year). This is a plan of care that involves all professionals who may be involved in the care of a resident who is designated as terminally ill. It allows for all involved with the care of the resident, including the resident themselves, their family/carer, staff and other professionals to agree and follow the same plan of care. This ensures a continuity of care and an understanding of the resident’s very specific needs at this sensitive and demanding time. It is an excellent way of working and has received high acclaim. Documentation forwarded to the Commission, following the three deaths of residents where the Liverpool Care Pathway philosophy has been used, evidences that care had been given by all involved to ensure that the resident was kept as comfortable as possible and that their specific care needs were met. Other recent professional involvement has included a physiotherapist who came to assess one of the residents whose care was looked at in detail to try and give some advice as to how the resident could better mobilise from bed to chair. Other recent professional involvement has included the local continence advisor, visiting chiropodist, G.Ps, District Nurses, visiting optician, a domiciliary dentist and a speech therapist to help assist one resident who is currently experiencing swallowing difficulties. The excellent links that the manager forms with specialist services ensure that the health of the residents is both upheld and that both she and the staff are made aware of how best to provide ant specialised care on a day to day basis. All residents’ individuality and dignity was noted as being upheld and all residents spoken to confirmed this to be the case. Comments received from relatives, residents and staff in relation to the care provided included: “They care so well for X. They provide full time care with excellent food, care and health care”. “Good as it gets. We are so fortunate to have Ridgecourt. Long may it remain at its standard of care.” “I always feel like X is living in her own home. I never have to worry if I can’t get in to se X each day. She always has her personal needs met and her clothes are kept beautifully. X thinks the staff are her family. If ever X is unwell the Doctor is always called. Ridgecourt was the best thing that ever happened for X and I hope she is able to end her days there as X is so happy there” “The home keeps us informed in any situation regarding health and X is kept clean and well fed”. Ridgecourt Residential Care Home DS0000066672.V337476.R01.S.doc Version 5.2 Page 14 “Good level of physical care”. “X has been a resident at the home for some time. X has relaxed considerably and is much happier and less anxious than she was previously. The level of care X receives is excellent and I am extremely happy with the service”. “They come quite close to being 100 efficient and work to a very high standard”. “I am reasonably independent but if I need help it’s there no problem and I’m confident that should my dependence increase I will receive any help I need”. “Excellent care provided. Staff trustworthy and caring”. A staff member fed back: “Our standard of care is good and we will adapt to the resident needs if and when needed”. A comment received from the relative of a resident who had recently died at the home stated: “ X died in April. We would particularly wish to record that the staff gave us every help and kindness during the X’s last days at the home”. Medications are stored properly in a locked fixed cupboard within a locked small office facility. Medication practices were noted to be mostly in order with all necessary records seen and the Mars recording sheet for medications administered up to date and complete. Although the home is not currently administering any controlled drugs at present there were correct records seen of when this last happened. In depth medication training is given by the manager to all staff involved in administering medication. The staff member then completes a work book regarding what they have learnt and the local supplying pharmacist marks this. Additionally the manager is looking to ensure that staff have the availability to attend external medication training with a local pharmacist in the near future. Only designated senior or experienced staff administer medication all of whom the manager stated had received medication training. The home’s last medication inspection was in June last year when all was noted to be in order. Small shortfalls regarding medication practices noted as this inspection included the lack of resident photographs on the residents’ medication administration sheet. Ridgecourt Residential Care Home DS0000066672.V337476.R01.S.doc Version 5.2 Page 15 Having these would further minimise any risk of medication error as any staff involved in administering medication would easily be able to identify which resident was being referred to with the use of a photograph, if for any reason they were unfamiliar with the home, i.e. if using a care worker from one of the group’s other homes. Also there was not a signatory list available of those regular staff who do administer medication. This made it more difficult to easily identify which staff member had administered what medication at which time. Ridgecourt Residential Care Home DS0000066672.V337476.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13, 14, 15 The quality in this outcome area is good. Residents enjoy a peaceful life at the home, with visitors encouraged and welcomed however the home’s activity programme may not be fully meeting the needs of the current group of residents. Staff respect residents’ personal choices and the home provides excellent nutritious and varied meals. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All residents spoken with stated that they were happy at Ridgecourt and enjoyed living there. Evidence of the way that the home tries to meet residents’ needs was seen in the following note on home’s notice board, which said: “Could a member of staff please read X his paper after coffee each morning for twenty minutes?”. The hairdresser was in home on day of inspection and some residents were joking with each other about having been made to look good, a conversation that several were enjoying and joining in on, which evidenced that the hairdresser’s visits are important to them. Other recent activities that have been enjoyed have included a local museum coming to give a talk about years gone by and bringing some exhibits which the residents found very interesting. Ridgecourt Residential Care Home DS0000066672.V337476.R01.S.doc Version 5.2 Page 17 A “pampered chef’s party” was hosted to raise money for the Devon Air Ambulance which involved a cookery demonstration with all sampling the food and wine afterwards followed by a raffle. Residents, their friends and relatives and relatives of past residents were all invited to attend and the evening was a great success. A resident recently had a 100th birthday party attended by local dignitaries, which was appreciated by all involved. The wife of one resident is invited to come daily for lunch or the evening meal to help maintain their relationship and when speaking to the resident concerned it was apparent that this was appreciated and had now obviously become a normal day to day occurrence. Equality and diversity is also promoted within the home. For example two female residents did not want a male member of staff to attend to their personal needs and as such were provided at all times with a female member of staff. However after a while one of these residents changed their minds and then chose to have the male member of staff attend to her needs and has been very happy with this arrangement, however it was her choice and she made the decision. The home provides for the spiritual needs of the residents taking into account individual spiritual choices/needs. For example a local minister and some of the church congregation attend for monthly service in home for those that wish to participate. Another resident has quite different spiritual needs being an active pagan and the home accommodates these very satisfactorily, with certain symbols etc being in evidence on the resident’s bedroom door. A resident comment received stated: “Staff are always polite and pleasant kind and attentive to X and us. There’s a home from home feel about the place. Residents are treated with dignity and not obliged to follow any “ house rules” or do anything they don’t want to do.” The resident’s beliefs are also correctly recorded in their care plan, which was undertaken with the participation of the resident and relative. However several residents, relative and staff feed back forms have also indicated that the one thing that the home could improve upon was to introduce more activities within the home for the residents with such comments being received as: “There are insufficient staff to regularly take X into the garden, something we had been told would happen when X came to live at the home”. Another relative also felt that the provision for crafts activities within the home was lacking whilst another stated that the one thing the home could improve upon would be: Ridgecourt Residential Care Home DS0000066672.V337476.R01.S.doc Version 5.2 Page 18 “To have some regular led activities to help stimulate the residents like singing or drawing or watching a nature programme etc”. A resident stated” There’s a therapist but that’s it. Otherwise the staff try to keep us entertained”. Visitors are welcomed and come and go as they wish. During the site visit one visitor came into the home and confirmed that they were made welcome and were satisfied with their relatives care. Another relative’s comment also stated: The one thing they do very well is the “reception of visitor”. Meals provided remain excellent. All residents again spoke highly regarding the quality of the meals they received, whilst the meal on the day of the inspection was appetising and enjoyed by all residents. A resident comment included: “Good varied diet and good quality of home cooked meals” Special dietary needs were being met which was confirmed by the resident who has diabetes and by a another newly admitted resident who has a specialist gluten, sugar and dairy free product diet. This resident stated that: “They follow my dietary needs very closely” and during the inspection it as noted that this resident’s meal was prepared completely separately from the others with the cook following a dietary chart provided by the resident’s next of kin. The present cook has been at the home for over twenty years and takes great pride in the planning and serving of quality meals. She is due to retire soon and the manger is aware that it will be very be very necessary to replace her with a cook of equal skill. In preparation for this a new food system workshop provided by given by the local Environmental Health department entitled, “Better food, Better business” has been attended by the manager. The manager is also currently looking at ways of increasing the variety of meals available which is seen as excellent practice as there was nothing but praise for the current variety and choice of food served. This evidences that the manager and staff are always considering ways of improvement to residents’ lives even though there may not be an actual need noted. Ridgecourt Residential Care Home DS0000066672.V337476.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. The quality in this outcome area is good. Arrangements for protecting residents and responding to their concerns are such that residents should be protected at all times. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home’s complaint policy remains displayed and is also contained within the home’s statement of purpose. There are blank complaints forms left in the outer hallway and a suggestion box in the same place to allow anyone to be able to complain in confidence if they so wished. Residents were quite clear as to how to complain and felt they could easily approach the manager or any staff member should they have any cause to. Returned feedback forms from the residents and their relatives confirmed that all were aware of the home’s complaints policy and would feel able to complain if they felt the need. Staff indicated in their feedback forms that they were aware of adult protection procedures. Seven staff attended Protection of Vulnerable Adult training in January this year which ensures that they are aware of how to identify abuse, which ultimately ensures residents are safe. The home has not received any complaints since the last inspection and for some time before that. Ridgecourt Residential Care Home DS0000066672.V337476.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. The quality in this outcome area is good. Ridgecourt is very comfortable, clean, well maintained and provides a safe standard of accommodation for the residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The tour of the home confirmed that the owner continues to maintain good environmental standards throughout the home by means of good maintenance and upgrading as required. The home’s electrical systems were updated, following the change of ownership eighteen months ago. Locks to residents’ bedroom doors are not provided as standard, but will be provided on request. The home presented as very clean and many residents and their relatives stated that the cleanliness and freshness of the home was something they all valued. Relative comments received included: Ridgecourt Residential Care Home DS0000066672.V337476.R01.S.doc Version 5.2 Page 21 “There are always flowers and plants around the sitting room and the Christmas decorations are very attractive and evocative”. “The home is exceptionally clean”. The home’s infection control measures were noted as continuing to be excellent with anti-bacterial gel having been placed throughout the home including central areas such as the entrance hall. There is a notice on the front door of the home asking people to think before they enter the home if they have a virus etc. New cleaning products have also been provided to help minimise the risk of infection and a new way of cleaning a room safely, when it becomes vacant, was to be demonstrated within the home the week following this inspection. All these measures continue to help prevent any potential spread of any infection, protecting the service users, staff and visitors to the home. The manager and home’s senior carer remain involved in being part of a local professional forum looking at how best to prevent cross infection, which again benefits residents by management and staff being made aware of the latest updates on this subject. Since the last inspection an existing ramp from the home’s sun lounge area to the front garden has been upgraded which has improved access for all residents as well as those who may need a wheelchair. All the trees surrounding the property have been risk assessed by a qualified tree specialist to ensure resident safety remains paramount. The manager has reviewed and updated the risk assessments regarding the home’s building as well as updating and reviewing the home’s fire risk assessment. Eight new door closures, new emergency lighting, resiting of the fire panel to enable better access and the replacement of all smoke detectors on a rolling programme have been/are being provided to help protect residents in the event of a fire. Staff also receive appropriate fire training and the home’s fire log book was in order. One resident’s bedroom was noted as having a portable heater in it, however the manager stated she had undertaken a full risk assessment in relation to the use of this and is also looking at making an alternative safer measure available to provide additional heating as required by the resident. A new Victorian fireplace has been fitted in the main lounge to be more in keeping with character of home and looks lovely. Some kitchen equipment has been replaced and since the employment of a maintenance person the downstairs hallway and some bedrooms have been redecorated. The manager has also endeavoured to make the gardens of the home more colourful and attractive for the residents to look at or wander in. There are further future plans to install an en-suite in room 5, provide a walk in shower in the existing upstairs bathroom and replace the existing bath hoist in the downstairs bathroom with a more modern and efficient model. Ridgecourt Residential Care Home DS0000066672.V337476.R01.S.doc Version 5.2 Page 22 Ridgecourt Residential Care Home DS0000066672.V337476.R01.S.doc Version 5.2 Page 23 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 consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30. The quality in this outcome area is adequate. Staff at the home are employed in adequate numbers to meet the residents’ personal care needs but not always their social care needs. The home’s recruitment programme was not always fully protecting residents. EVIDENCE: All residents confirmed that the staff care for them well. On the day of inspection there were thirteen residents in the home. On duty there was the manager, the home’s senior carer who was designated to cook and two other carers. Staff training is provided regularly. Recent training provided has included statutory fire training, first aid, Protection of Vulnerable Adult training and the provision of ongoing training toward nationally recognised care qualifications. However not all of the staff have attended this raining, for one reason or another and consequently there are some gaps in the staff attendance. Currently, six staff out of twelve staff have a nationally recognised care qualification and four more are working towards this qualification. Improved induction training has also been provided in line with the required standards. This level of training ensures that staff, that attend, are both appropriately trained and consequently able to provide suitable care for the residents at the home. Staff on duty were spoken with and it was evident that they took pride in their role and felt that ensuring residents had a good quality of life, irrespective of need or diversity, was the most important part of their role. Ridgecourt Residential Care Home DS0000066672.V337476.R01.S.doc Version 5.2 Page 24 The home’s cleaner has been on long term sick leave and consequently regular care staff have had to incorporate some cleaning duties within their roles which has on occasions left the home short of care staff to work with residents in a social manner which is reflected in the comments received about the home not having enough staff to undertake activities with residents for example two comments received stated that the home could improve by: “By employing more staff” and for the management: “To consult staff on their ideas for the home”. and finally a comment from a resident stated: “I usually get the care and support I need but the that the staff can be very busy”. The home does maintain a relatively stable staff group. Changes that have occurred have been due to ill health and retirement with two key staff on long term sick leave. However this has caused some difficulties in maintaining a continuity of care and on occasions has made it difficult to release the senior carer and the manager to attend senior level training, something that the manager has recognised and is in the process of addressing with the registered provider. As the registered provider also owns two other establishments there has been some availability to utilise staff members from these establishments in the case of any sickness etc within Ridgecourt. This has worked relatively well and has allowed the manager at Ridgecourt the opportunity to maintain reasonable staffing levels when it has not been possible to do so using the home’s own staff. However some shortfalls were noted in this practice for example the staff contract of one care worker employed at Ridgecourt was found to be for another home within the group and not for Rigecourt where the staff member was based permanently. Also a current enhanced criminal record bureau check was not available for one overseas member of staff who was working at the home in an unsupervised capacity. It was also noted that the work permit for this member of staff was in relation to the staff member being based at the other home within the group and not at Ridgecourt, where the staff member does actually now work full time as well as live. Therefore it would be good practice to write to the Home Office to inform the relevant department that this staff member, who requires work permit to work in the United Kingdom, is now actually working in a different care home than the one registered on their work permit. Ridgecourt Residential Care Home DS0000066672.V337476.R01.S.doc Version 5.2 Page 25 A second member of staff had been seconded to Ridgecourt from another of the group’s homes, however on transfer the manager at Ridgecourt was not provided with necessary recruitment details. These included an enhanced CRB check, two written references, contract as well as a lack of evidence to show that any induction had been undertaken. The manager did make the owner aware of these shortfalls in the staff member’s recruitment, which was evidenced in the weekly written report from the manager to the owner earlier in the year. Since noting these shortfalls the manager applied for the necessary documentation. Ridgecourt Residential Care Home DS0000066672.V337476.R01.S.doc Version 5.2 Page 26 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 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,and 38. The quality in this outcome area is good. The home is managed efficiently and well, with the management of the home being easily available and approachable. The home provides a safe, secure environment where residents’ safety and well being is maintained. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager has now completed her NVQ level 4 in care. She is well respected by both staff and residents. Residents spoke highly of her ability to help them and her willingness to listen and act upon any concern etc they may have. She also maintains her knowledge of the skills required to manage and work in a residential setting for the elderly by regularly attending other training relevant to her post. For example she has recently applied to undertake an advanced course in counselling. Ridgecourt Residential Care Home DS0000066672.V337476.R01.S.doc Version 5.2 Page 27 The manager has stated that she and the Registered Provider have now built up a good working relationship and there were records of the weekly meetings that take place between the owner and manager, which clearly show that both openly discuss what is in the best interests of the residents. A feedback comment received stated: “As far as we can tell this home is a model of how all homes’ caring for older people should be. We think this is down to the staff, in particular the manager. We would be happy to recommend it”. All residents are given annual survey forms and all completed ones are kept in the home’s statement of purpose, which is on view in hallway. As a result of feedback received from last years’ surveys the ramp had been improved from the sun lounge to allow easy access to the front gardens both by foot and by wheelchair. Other smaller issues that were taken up included the provision of fresh fruit and larger serviettes at meal times. Also the manager is to implement a wider choice of meals to be provided and the upstairs bathroom will upgraded to provide a walk in shower facility. However it was noted that a comment received from a staff member indicated that the staff member did not feel the current owner valued them as much as the previous owner had due to the staff member feeling that the new owner had less of a personal involvement with the staff at Ridgecourt than the previous owner had. The manager undertakes an annual quality review, which is in depth and on going and allows her to have an overview of the standards operating within the home including the home’s strengths and weaknesses. The manager completed the Annual Quality Assurance Assessment required by the Commission professionally with a great deal of information being provided. However as the manager does not have access to the Internet the Commission could not forward it to the home electronically and consequently the manager could not return it electronically, completing it by hand. Having Internet access would be beneficial for the manager at the home to aid communication and allow her the ability to easily access general research as well as the Commission’s website. The residents or the residents’ families/advocates deal with any financial matters. The manger does not deal with residents’ monies. Residents’ health and safety continues to be maintained within the home and the manager continues to update risk assessments and comply with required health and safety legislation as necessary. Electrical testing of portable appliances has been undertaken as required, and there was an up to date risk assessment in relation to the storage and use of chemicals within the home. The home’s policies and procedures were updated in March this year and the home’s accident reporting was in order, with necessary details forwarded to Commission as needed. Ridgecourt Residential Care Home DS0000066672.V337476.R01.S.doc Version 5.2 Page 28 The last environmental health visit was in August last year when all was noted as in order. Maintaining these environmental health standards ensure residents continue to be cared for in safe and as far as possible risk free environment. The manager has recently enrolled in the “My Home Life” programme, which is sponsored by Age Concern and informs management and staff as to how residential care is perceived by the residents themselves. This allows those involved in the programme to gain valuable insights into how it can actually feel to be resident in a home and how the management and staff can recognise and hopefully overcome any negative or worrying times for a resident. Regular staff supervision is provided and written records were seen whilst staff confirmed that this aspect helps support them in their role. Although informal staff meetings are held very regularly, the manager is now to commence a more formal structured meeting so that staff can have the opportunity to discuss any concerns or feelings they may have regarding their role. Records of these meetings will then be kept and will be available for reference. The manager is also to make the same available for residents so that any new ideas such as the move towards offering a more structured approach to activities within the home can be openly discussed and an agreement reached as to what would best suit the residents. Having these meetings operating on a regular basis will ensure that there are good and open communications within the home and will allow for an exchange of views in a secure and supportive setting. Ridgecourt Residential Care Home DS0000066672.V337476.R01.S.doc Version 5.2 Page 29 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 3 9 2 10 4 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 4 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x x x 4 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x x x x 3 Ridgecourt Residential Care Home DS0000066672.V337476.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? None made at 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 OP29 Regulation 19 (Sch. 2) Requirement The registered manager must ensure that the recruitment programme within the home is fully robust. This must include an enhanced Criminal Record Bureau check being obtained before a member of staff is designated to work in an unsupervised manner with residents. All other necessary checks should also be carried out prior to employment, including the taking up and receipt of two written references as well as proof of identity of the prospective staff member. This will ensure that residents will be protected at all times by the recruitment of suitable staff. Timescale for action 20/07/07 Ridgecourt Residential Care Home DS0000066672.V337476.R01.S.doc Version 5.2 Page 31 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 OP9 Good Practice Recommendations The home’s medication systems should be further reviewed to include: The inclusion of each resident’s photograph on their medication administration record sheet; A list of each staff member’s signatory who has responsibility for administering medication within the home. The registered manager should seek out residents’ views regarding the provision of a more regular planned activity programme. The registered provider should continue to provide a suitable lock to residents’ bedroom doors to allow a resident’s privacy to be fully maintained if so desired. The registered manager should review the staffing numbers and allocation of staffing within the home to ensure that there is enough staff on duty to provide for residents’ social needs. The registered manager should ensure that all staff members designated to work at the home have undergone an induction programme of training. The registered manager should also ensure that staff attend the statutory training provided within reasonable timescales. 2 2 OP12 OP24 3 OP27 4 OP30 Ridgecourt Residential Care Home DS0000066672.V337476.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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