CARE HOMES FOR OLDER PEOPLE
Ridgecourt Residential Care Home Ridgecourt Bridgetown Hill Totnes Devon TQ9 5BH Lead Inspector
Judy Cooper Unannounced Inspection 24th April 2006 10:00 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.V289664.R01.S.doc Version 5.1 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.V289664.R01.S.doc Version 5.1 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.V289664.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 25/09/06 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, 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. There is parking to the front of the home. The home has recently changed ownership (January 2006) having been re-registered to Ogwell Grange Ltd, with the identifeid Responsible Person being named as Mr Robin Sutton, who is already an existing care home owner with several years experience. Ridgecourt Residential Care Home DS0000066672.V289664.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This site visit took place on Monday 24th April between 10.00a.m and 4.45 p.m. Opportunity was taken to look at the general overall care given to all residents. The care provided for three 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 two visitors 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 several completed questionnaires from residents, relatives, and other interested parties, has provided further feedback 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:
Ridgecourt continues to provide a comfortable, secure and caring environment, where residents’ individuality is encouraged and upheld. Basic residents’ rights, such as dignity, respect and privacy also continue to be firmly upheld which was, again, confirmed by the residents themselves. The residents continue to receive excellent meals, visitors are always welcomed, various informal activities are made available and the local community are invited to visit the home when appropriate/desired. The staff team continue to be well trained and able to meet the needs of the residents with the provision of appropriate, on-going relevant training. Ridgecourt Residential Care Home DS0000066672.V289664.R01.S.doc Version 5.1 Page 6 The homes real strength remains the high value the manager and staff place on maintaining a good individual quality of life for each resident. The residents themselves confirmed that they felt valued and their opinions are sought in all sorts of aspects involved with the running of the home. The new owner, manager and staff continue to monitor the quality of care given within the home and are currently in the process of completing the home’s annual quality audit. This home continues to maintain excellent standards of care with all requirements continuing to be met and only two recommendations made following this inspection. What has improved since the last inspection?
Additional training has been made available to staff members which ensures that staff continue to maintain an up to date awareness of new methods etc in the delivery of care which, in turn, benefits residents by ensuring they are cared for by an experienced and staff group. The recently registered new owner is in the process of auditing what general physical improvements are needed to ensue the environment remains of a good standard and is improved upon where necessary. To this end an upgraded electrical system has recently been installed within the home. The manager has further increased the home’s activity programme and has instigated some new experiences for the residents such as a recent “Body Shop” party, which proved popular with the residents. Due to Ridgecourt now being part of a group of three homes, all owned by the same experienced owner, who purchased Ridgecourt, the manager has been, on occasions, able to capitalise on the use of other experienced, suitable staff from the other two establishments if required i.e. in the case of staff sickness etc. This helps provide a continuity of care and reduces the pressure on the manager to find staff at short notice. Ridgecourt Residential Care Home DS0000066672.V289664.R01.S.doc Version 5.1 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Ridgecourt Residential Care Home DS0000066672.V289664.R01.S.doc Version 5.1 Page 8 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.V289664.R01.S.doc Version 5.1 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 The quality in this outcome area is good. The admission process continues to be well managed and residents are given clear information regarding the service prior to admission so that they, and their relatives, can make an informed decision. EVIDENCE: Since the last inspection the home has admitted some new residents. Three new residents were talked with during the inspection. All were able to confirm that their admission had been undertaken in such a manner as to allow them to be aware of what services the home could offer. The manager had visited two residents prior to admission to the home and the third visited the home themself. The prospective residents and their families had been given access to necessary information including the home’s statement of purpose. These documents are currently in the process of being amended to reflect the new
Ridgecourt Residential Care Home DS0000066672.V289664.R01.S.doc Version 5.1 Page 10 owner’s details and any other relevant changes associated with the change of ownership in February this year. Up to date and relevant contracts were in place for all the residents. All of the homes’ own private contracts are in the process of being amended to reflect the new owner’s name etc, following the change of ownership. The home does not provide an intermediate care service. Ridgecourt Residential Care Home DS0000066672.V289664.R01.S.doc Version 5.1 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 The quality in this outcome area is excellent. All residents are looked after very well in respect of their health and personal care needs. Residents’ privacy and dignity is upheld and their life style choices respected. EVIDENCE: Care plans were seen in respect of the three residents who were case tracked. These were thorough and covered all required care needs as well as social and psychological needs. One resident, who wanted to, had been fully involved in the drawing up of their care plan and continued to be involved in the regular monthly review process. For the others, relatives had taken on this role. In all three cases the resident or their relative/advocate was involved in the monthly care planning reviews which ensured that the residents are as involved as much as possible in the provision for their care needs, either directly or through their advocates involvement. The residents’ health care needs were being fully met, including any specialist needs.
Ridgecourt Residential Care Home DS0000066672.V289664.R01.S.doc Version 5.1 Page 12 One resident had specific needs in relation to her diabetes and she confirmed that she felt very confident with the way that the home’s staff managed her condition. This had allowed her to relax and not be so concerned about the condition, which in turn allowed her to enjoy life at the home. The manager had initiated links with the diabetic clinic to fully ensure that specialist advice was made available. Medications were well managed with one resident stating that she had felt confident enough to allow the home’s staff to administer her medication after many years of having done it herself. Any new presenting needs are fully reviewed i.e. increases in falls, continence needs etc and an analysis undertaken to ensure the most appropriate care is provided. Other professionals are also asked for advice as required and currently the manager is in discussions with a speech therapist in relation to one of the residents who is experiencing some problems with eating. All residents’ individuality and dignity was noted as being upheld and all residents spoken to confirmed this to be the case. An example of this involved the manager discreetly ensuring that a resident, who has some difficulty with hearing, had a notepad and pen easily to hand to aid communication. Ridgecourt Residential Care Home DS0000066672.V289664.R01.S.doc Version 5.1 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 The quality in this outcome area is excellent. Residents continue to enjoy a peaceful, pleasant yet varied life at the home, with visitors encouraged and links encouraged and maintained with the local community. Various informal activities are made available with new activities also tried out to help vary residents’ life at the home. Excellent meals continue to be provided. EVIDENCE: All residents spoken with stated that they were happy at Ridgecourt and enjoyed living there. The manager has recently opened up some new social opportunities including a recent “Body Shop” party, which was enjoyed by all who attended. A small amount of money raised from the party has bee reinvested into the purchase of some new pampering products, which has allowed the staff to give some additional manicures etc which some residents have enjoyed. Visitors are welcomed and come and go as they wish. During the site visit two visitors were in the home and confirmed that they were always made welcome with a cup of tea and could visit as and when they wished.
Ridgecourt Residential Care Home DS0000066672.V289664.R01.S.doc Version 5.1 Page 14 Meals provided remain excellent. All residents 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. Special dietary needs were being met which was confirmed by the resident who has diabetes who gave full praise as to the cook’s ability to fully meet her very specific dietary needs, something which had been a past concern of hers. Good use was being made of fresh vegetables and fruit both of which formed part of the meal served during the visit. The cook has been at the home for over twenty years and takes great pride in the planning and serving of quality meals. A comment contained within a returned resident’s questionnaire stated, “ the meals couldn’t be better. Well presented, the best quality, variety and a real joy”. Ridgecourt Residential Care Home DS0000066672.V289664.R01.S.doc Version 5.1 Page 15 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 The quality in this outcome area is good. Arrangements for protecting residents and responding to their concerns are satisfactory. EVIDENCE: The home’s complaint policy remains displayed and is also contained within the home’s statement of purpose. 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. During the home’s annual quality audit, which was taking place during this visit, the manger ensures that residents remain aware of the complaints policies. Three returned questionnaires from the residents who had been case tracked confirmed that all three and their families were aware of the home’s complaints policy. Ridgecourt Residential Care Home DS0000066672.V289664.R01.S.doc Version 5.1 Page 16 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 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. EVIDENCE: The tour of the home confirmed that the new owner is building on the previous good environmental standards that were already in place. The home’s electrical systems have updated, following the change of ownership and the manager has also been asked to identify any other needed works. Routine general upgrading continues to take place, including routine decorating etc. One large bedroom had been completely re decorated/upgraded prior to a new resident occupying it. The manager has recently updated the home’s fire risk assessment and has ensured, through conversations with the local fire and rescue service that it is in accordance with their recommendations.
Ridgecourt Residential Care Home DS0000066672.V289664.R01.S.doc Version 5.1 Page 17 Locks to residents’ bedroom doors have not yet been provided, but the manager is confident that the new owner will be providing as required. The home presented as very clean and when a resident was asked if the home is fresh and clean gave the response, as “it is exceptional”. The home’s infection control measures were noted as being excellent with antibacterial gel having been placed throughout the home including central areas such as the entrance hall. This aids the potential spread of any infection, protecting both the residents 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 staff being made aware of the latest updates on this subject. Ridgecourt Residential Care Home DS0000066672.V289664.R01.S.doc Version 5.1 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 The quality in this outcome area is good. Staff at the home are well trained and supported, and employed in sufficient numbers to meet the residents’ needs at all times. EVIDENCE: All residents confirmed that the staff care for them well. Training is provided regularly. Recent training provided has included statutory fire training and training on the use of the Liverpool integrated care plan: a document to be used by all involved in the care of any one with a terminal illness to ensure consistency. Further training in skin care is being made available on the 25th of this month for all staff who wish to participate. This level of training ensures that staff 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. An example of this concerns one of the residents who was case tracked as part of this inspection process. As this resident had some minor difficulties with social integration, the manager and staff have helped her become more socially active within the home, by gentle and appropriate encouragement, which has benefited the resident. The resident’s next of kin also confirmed this within the home’s annual relatives feedback form by stating that their relative
Ridgecourt Residential Care Home DS0000066672.V289664.R01.S.doc Version 5.1 Page 19 was now beginning to relax and feel at home at Ridgecourt. The resident herself also confirmed that she was happy and comfortable at the home and felt well cared for. The home maintains a very stable staff group. Minor changes that have occurred have been due to ill health and retirement. This overall staff stability allows residents to feel secure and confident of the carers’ ability to care for them. Since the last inspection the manager has not appointed any new staff members. She has however re-appointed a previously well thought of exmember of staff who had a two year break in her service from the home. All of this staff member’s records were seen to be in order and the manager had obtained a new recent reference from her last employer whilst not at the home. However a new enhanced CRB should also have been requested at the same time. This is due to the fact that there was a break in service by the staff member (although there was the previous enhanced CRB disclosure available from when the member of staff was last working at the home). This was a misunderstanding on the manager’s part, rather than a deliberate omission, as she had assumed the previous disclosure was still valid. She will now apply for an updated CRB disclosure immediately. As the new owner already 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 well and has allowed the manager at Ridgecourt the opportunity to remain fully staff using experienced and well trained staff, known to the group. Ridgecourt Residential Care Home DS0000066672.V289664.R01.S.doc Version 5.1 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 The quality in this outcome area is good. The home is managed efficiently and well, with the manager being easily available and approachable. The registered manager undertakes her role professionally and has an awareness of residents’ needs and the staffs’ abilities to meet them. The home provides a safe, secure environment where residents’ safety and well being is maintained. EVIDENCE: The manager has almost completed her NVQ level 4. 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. They felt confident because they felt she ran the home efficiently and in their best interests.
Ridgecourt Residential Care Home DS0000066672.V289664.R01.S.doc Version 5.1 Page 21 The manager was in the process of undertaking the home’s annual quality review when the site visit was undertaken. Very positive comments were received generally as part of the resident feedback and one particularly reflected how a newly admitted resident, who formed part of the case tracking exercise was now feeling: “I can only say that life is still worth living”. The residents or the residents’ families/advocates deal with any financial matter. The manger does not deal with residents’ monies. The manager stated that she had begun to build up a good relationship with the new owner/responsible person who visits weekly and for whom the manager provides a written weekly report regarding the running of the home generally. There is also a need for the identified responsible person to undertake a formal monthly review of the service and provide the manager with a written record of this visit as well as forward a copy of the report to the Commission under regulation 26. This process also ensures that the home continues to be run in the best interests of the residents and continues to meet their needs. 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. Ridgecourt Residential Care Home DS0000066672.V289664.R01.S.doc Version 5.1 Page 22 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 4 9 4 10 4 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 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 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 x 3 x 3 x x 3 Ridgecourt Residential Care Home DS0000066672.V289664.R01.S.doc Version 5.1 Page 23 Are there any outstanding requirements from the last inspection? No 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. Standard Regulation Requirement Timescale for action 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 2 Refer to Standard OP24 OP29 Good Practice Recommendations The registered provider should provide a suitable lock for residents’ bedrooms to allow a residents privacy to be fully maintained if desired. The registered manager should ensure that an enhanced disclosure check, from the Criminal Records Bureau, is obtained in respect of any staff member that returns to work at the home following a break in service at the home. The responsible person should ensure that there is a formal monthly visit made to the home, with a written record of the visit made and given to the manager, and a copy also forwarded to the Commission. 3 OP33 Ridgecourt Residential Care Home DS0000066672.V289664.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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