CARE HOMES FOR OLDER PEOPLE
Ridgegate 88 Doods Road Reigate Surrey RH2 0NR Lead Inspector
Helen Dickens Unannounced 16 August 2005 09:30 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Ridgegate H58-H09 S13762 Ridgegate V239100 160805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Ridgegate Address Ridgegate 88 Doods Road Reigate Surrey RH2 0NR 01737 242926 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Governors of Ridgegate Home Ridgegate, 88 Doods Road, Reigate, Surrey, RH2 0NR Mrs L Fautley Care Home (CRH) 25 Category(ies) of Old age, not falling within any other category registration, with number (OP) 25 Both of places Ridgegate H58-H09 S13762 Ridgegate V239100 160805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 23 August 2005 Brief Description of the Service: Ridgegate is a large house in a pleasant residential area of Reigate in Surrey. The accommodation is arranged on four floors which can be reached by the staircase or the lift. Residents all have single rooms, and some have en-suite facilities. There is a large comfortably furnished lounge on the ground floor and two smaller lounge areas are available for residents to use. The kitchen and dining room are on the lower ground floor. The home has a large well-maintained garden and there is a small car parking area in front of the house. Ridgegate H58-H09 S13762 Ridgegate V239100 160805 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over five and a half hours and was the first inspection to be undertaken in the Commission for Social Care Inspection year April 2005 to March 2006. The inspection was carried out by Helen Dickens, Lead Inspector for the service. Lorraine Fautley, Registered Manager, represented the establishment. Comments in this report are included with the permission of those quoted. A full tour of the premises took place. The inspector spoke with 3 residents at length, and met or saw all the other residents who were in the home on the day of the inspection. Three visiting relatives were also interviewed. The inspector interviewed 2 members of staff and examined a number of files and documents during the inspection. This was a positive inspection. The inspector would like to thank the residents, visitors and staff for their time, assistance and hospitality. What the service does well:
There was an open and positive atmosphere in the home and residents appeared happy and well cared for. The home was clean and odour free and the standard of furnishings was good. Bedrooms were all personalised and communal areas were homely and comfortable. Residents spoke well of the home and comments like ‘I can’t fault it’ and ‘It’s pretty good here’ were typical. Favourable comments were received about the staff, the food, and the general facilities. The home has a monthly activities programme and a good variety of leisure opportunities for residents. Ridgegate demonstrates a commitment to involving residents in the day-today running of the home. The home holds two sets of residents meetings; one where all residents are invited and are consulted; and the other where a smaller sub-committee are involved in more detailed work. Staff demonstrated a good ‘team’ approach and are positive about their work. They commented on the good standards in the home and the training available to them. Staff interviewed were committed to, and enjoyed working with, these particular residents. The Registered Manager is a good team leader and provides a supportive environment for both staff and residents. Ridgegate H58-H09 S13762 Ridgegate V239100 160805 Stage 4.doc Version 1.40 Page 6 What has improved since the last inspection? What they could do better:
At the time of the last inspection in August 2004 the home was planning to install a new lift. This work was holding up other decorative work (e.g. replacing the carpets) which was to be carried out following the lift being installed. The plans regarding the new lift have been reviewed and a different lift is now planned but has still not yet been installed. Some of the purely decorative matters needing attention have now become more urgent and the inspector was particularly concerned about the worn stair carpet which will need replacing. The home must apply for a minor variation to their registration to accommodate one resident who has developed special needs. This is a straightforward process but needs to be done as soon as possible to ensure the home is operating within its registration conditions. The home must acquire the February 2005 version of the Surrey multi-agency procedures for the protection of vulnerable adults and ensure that in-house policies dovetail with this countywide version. A number of minor health and safety and decorative matters are raised in the main body of the report and requirements and recommendations on these issues are contained at the end. Ridgegate H58-H09 S13762 Ridgegate V239100 160805 Stage 4.doc Version 1.40 Page 7 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. Ridgegate H58-H09 S13762 Ridgegate V239100 160805 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Ridgegate H58-H09 S13762 Ridgegate V239100 160805 Stage 4.doc Version 1.40 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 standard(s) 1,3,4 and 5 The home offers good information for prospective residents to enable them to make an informed choice about where they might like to live. The home offers respite care and trial visits for prospective residents to try out the facilities of the home. EVIDENCE: The information available for prospective residents gives a good overview of the ethos, facilities and services of Ridgegate. There is a particularly welldesigned resident-friendly leaflet which sets out this information accurately, in a clear and concise way, and includes photographs of residents, house and garden. Resident’s files sampled during the inspection showed that there were comprehensive assessments of resident’s initial and developing needs and this would enable staff to support people in the appropriate manner. The inspector was informed that one resident had developed special needs, which were not currently within this home’s category of registration. The home demonstrated they were meeting the resident’s needs and were advised
Ridgegate H58-H09 S13762 Ridgegate V239100 160805 Stage 4.doc Version 1.40 Page 10 to apply for a minor variation; a condition will therefore be attached to their current registration to allow them to have one named resident with these special needs accommodated within the home. On the day of the inspection one respite resident and their relative had returned to the home to bring a gift for staff. This resident had decided to move in permanently and agreed to speak with the inspector about their experiences of this home. They were very happy with all aspects of the service and said they had been shown ‘great kindness’ by staff. They complimented the food and said there was a great variety ‘and plenty of it.’ Other homes had been considered and visited but Ridgegate was ‘by far the most welcoming.’ Ridgegate H58-H09 S13762 Ridgegate V239100 160805 Stage 4.doc Version 1.40 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 standard(s) 7,8 and 10 The home demonstrated good knowledge of resident’s health and social care needs which would ensure residents received the necessary support in a timely manner. EVIDENCE: Care plans sampled had been generated from comprehensive assessments of resident’s needs. The plans enabled staff to care for and support residents appropriately. The inspector would have liked to have seen more risk assessments, particularly for the resident with special needs, and this was discussed with the Registered Manager. However, the staff member who had completed two of the care plans sampled should be complimented for the particularly thorough way the resident’s needs had been identified and documented. All residents appeared well cared for and there was evidence on resident’s files that health needs had been identified and addressed. The weekly activities programme included an exercise class, which would promote good physical and mental health. Residents could register with a GP of their choice and this is confirmed in the service user guide. One of the visitors spoken with confirmed a range of health professionals were involved with their relative and said the
Ridgegate H58-H09 S13762 Ridgegate V239100 160805 Stage 4.doc Version 1.40 Page 12 home was always ‘quick to call the doctor’ if there were any health problems. The inspector saw many instances of residents being treated in a respectful manner and arrangements for personal care and visiting were in place to ensure privacy. There are currently no shared rooms in Ridgegate. Ridgegate H58-H09 S13762 Ridgegate V239100 160805 Stage 4.doc Version 1.40 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 standard(s) 12,13 and 14 A range of social, leisure and faith opportunities at Ridgegate enable residents to engage in fulfilling pursuits where that is their wish. Family and friends are welcomed and residents are encouraged to be involved in the day-to-day running of the home. EVIDENCE: The activities programme at Ridgegate showed a variety of social and therapeutic opportunities for residents. Regular activities included the musical movement exercise class, the weekly inter-denominational church service, ‘crossword time’, bingo sessions, regular visits from the hairdresser, chiropodist and a beauty therapist, piano and keyboard entertainment and video afternoons. The regular programme was supplemented with one off outings and trips in the new mini-bus, and in-house celebrations for special occasions such as birthdays. The home also has its own ‘shop’, which is open every Wednesday and Friday for residents to buy personal and other items, and there is a library area. Up to date information on activities is circulated to residents in a clear and attractive format. Visitors are encouraged at all reasonable times and are invited to take part in activities or to stay over, by arrangement. The visitors spoken to on the day of the inspection were complimentary about the home, one saying ‘the staff are so nice…they are charming to visitors and there is a beautiful atmosphere.’
Ridgegate H58-H09 S13762 Ridgegate V239100 160805 Stage 4.doc Version 1.40 Page 14 The home has a number of ways of involving residents and the inspector sampled the minutes of the resident’s committee meetings, and the general resident’s meetings. These two separate meetings gave the larger group of residents the opportunity to have a say and participate, but allowed a smaller group of more interested residents (the Committee) to have even greater involvement Ridgegate H58-H09 S13762 Ridgegate V239100 160805 Stage 4.doc Version 1.40 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 standard(s) 16 and 18 Policies are in place to ensure resident’s and relative’s complaints are taken seriously and acted upon. Residents are safeguarded from abuse by the training given to staff, but written policies for the protection of vulnerable adults need to be revised and updated. EVIDENCE: There had been no complaints since the last inspection. The previous advice given regarding the length of time the home should take to investigate complaints has been acted upon. In addition to the complaints procedure, residents have opportunities at the two different resident’s meetings to raise issues of concern. The Registered Manager was clear about the procedure for protecting vulnerable adults and she carries out staff training together with a video, which has been acquired for that purpose. However, the in-house procedure manual gives the impression that the home should investigate cases of suspected abuse themselves. This is at odds with the accepted policy in Surrey where all organisations have regard to the Surrey multi-agency procedures for the protection of vulnerable adults. The home must furnish themselves with a copy of the February 2005 policy, cascade the contents to all staff, and revise their in-house policy so that it dovetails with the local Surrey procedures. Ridgegate H58-H09 S13762 Ridgegate V239100 160805 Stage 4.doc Version 1.40 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 standard(s) 19,20,21,22 and 25. The home is generally safe and well maintained though there are a number of issues needing attention in order to fully protect residents and meet these Standards completely. EVIDENCE: The layout of the building is on four floors and therefore accessibility can be quite time consuming for example, getting everyone to the dining room on the lower ground floor using the small lift. However, the home is indeed very homely and residents were complimentary about the layout and rooms, several commenting to the inspector that they had nice bedrooms. One resident had lost a knob from the chest of drawers and the Registered Manager agreed to replace this as soon as possible. The hot water temperatures in some resident’s hand basins were either too hot or too cold; they need to be regulated to around 43C and a requirement will be made in this respect. There is evidence of a programme of renewal and refurbishment but sadly this has been delayed by the review of plans for a new lift, outlined in the summary
Ridgegate H58-H09 S13762 Ridgegate V239100 160805 Stage 4.doc Version 1.40 Page 17 at the beginning of this report. The stair carpet to the upper floor is completely worn in three places and the inspector has asked that a risk assessment be carried out and the carpet made safe as soon as possible. Other carpets in various parts of the home were patched and needing replacement and there was peeling wallpaper in one of the corridors. The temporary hairdressing salon has unsightly flooring (where a bath has been removed) and pipe work which is not covered. The door is kept shut when not in use and residents only use the room when accompanied by the hairdresser. However, this must only be a temporary arrangement as the facility is unsatisfactory in its present condition. There is an area in a kitchen storeroom, which has been treated for damp, but the decorative work to make the walls good has yet to be completed. This is unsightly and unhygienic given that some vegetables were being stored in the room at the time of the inspection. On the positive side, recent redecoration to a corridor and two residents rooms had been carried out to a high standard and the bedrooms generally were nicely decorated and attractive for residents. The garden was well maintained. The Registered Manager said that the visit to the kitchen by the environmental health department following the last inspection found that they were happy with the arrangements and level of cleanliness in the kitchen area. There were very pleasant communal areas within the home allowing spaces for a library, religious services, leisure and social activities as well as the dining and sitting areas. Most residents had en-suite facilities and there were also shared facilities. Assisted bathrooms were also available. One of the toilets had been fitted with a high seat and the connections at the back needed some attention with regard to hygiene and improving the finish. The old toilet seat had been left by the side and was quite dusty; the Registered Manager removed this later in the day. Also, one of the toilets contained gloves, aprons and bags for the use of staff which were labelled by hand in large black letters. The inspector felt this detracted from the otherwise homely appearance of the toilet facilities and the Registered Manager said a more discreet way of keeping such items would be identified. There were suitable adaptations and equipment throughout the home and the inspector noted that all the assisted bath equipment had just been inspected within the last month. Ridgegate H58-H09 S13762 Ridgegate V239100 160805 Stage 4.doc Version 1.40 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 Resident’s needs are being met as the number and skill mix of staff is sufficient to support them. EVIDENCE: During the inspection it was noted that residents were being supported in a timely fashion and there were sufficient numbers of staff on duty throughout. Staff rotas were available for inspection and senior staff were observed to be offering supervision and support to other staff. Ridgegate H58-H09 S13762 Ridgegate V239100 160805 Stage 4.doc Version 1.40 Page 19 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,36,37 and 38 Resident’s benefit from the ethos, leadership and management approach of the home. There were a few outstanding decorative and health and safety matters, which detracted somewhat from the otherwise safe and homely environment at Ridgegate. EVIDENCE: The Registered Manager has been in post for many years and the home benefits from her experience and professionalism. Clear lines of responsibility were evident and staff were clear both about their own responsibilities, and the part they played in the wider team. Staff supervision for care staff was a combination of one to one meetings and group supervision. The Registered Manager said that staff are given the opportunity before and after group supervision, to have one to one discussions if necessary. In total, the number of sessions exceeds the required 6 sessions per year for each member of the care staff.
Ridgegate H58-H09 S13762 Ridgegate V239100 160805 Stage 4.doc Version 1.40 Page 20 A number of minor decorative and health and safety matters are raised elsewhere in this report including the stair carpet, water temperatures and the need for additional risk assessments. There was also a bottle of toilet cleaner left in one of the bathrooms which was removed immediately by the manager. The hazardous substances cupboard was secure and all staff have received training in the control of substances hazardous to health. Ridgegate H58-H09 S13762 Ridgegate V239100 160805 Stage 4.doc Version 1.40 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 x
COMPLAINTS AND PROTECTION 2 3 2 3 x 3 2 x STAFFING Standard No Score 27 3 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 3 3 x x x 3 x 2 Ridgegate H58-H09 S13762 Ridgegate V239100 160805 Stage 4.doc Version 1.40 Page 22 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP4.1 Regulation 14(2)(a) Requirement Timescale for action 16.9.05 2. OP7.3 13(4)(c 3. OP18.1 OP18.2 OP18.3 13(6) 4. OP19.1 OP19.2 23(2)(b) 23(2)(d) The home must review the assessment of one resident whose needs have changed, and if necessary, apply to CSCI for a minor variation on their conditions of registration. The home must review its use of 16.9.05 risk assessments and consider whether there are sufficient areas covered to safeguard residents. The detail of this was discussed with the Registered Manager. The home must obtain a copy of 16.9.05 the Surrey multi-agency procedures for the protection of vulnerable adults, dated February 2005. Staff training should include reference to these procedures. The homes inhouse policy must be revised to make it consistent with these county-wide procedures. The home must attend to the following outstanding decorative/safety issues within the stated timeframe; Risk assess and make safe the 16.9.05 worn stair carpet to the upper floor of the home. Patched and worn carpet in other
Version 1.40 Ridgegate H58-H09 S13762 Ridgegate V239100 160805 Stage 4.doc Page 23 areas of the property needs to be repalced 16.11.05 The home must review the continued use of the temporary hair salon and inform CSCI when the permanent arrangements are likely to be in place. 16.9.05 The home must repair the damp damage in the kitchen store room. 16.9.05 5. OP25.8 13(4)(a) The home must review the water 23.8.05 temperatures in individual bedrooms as highlighted with the Registered Manager. Hot and cold water must be available to each resident, and the hot water in each bedroom should be thermostatically controlled to around 43C. The home must ensure that 17.8.05 hazardous substances are safely stored away at all times. 6. OP38.3 13(4)(a) 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 OP21 Good Practice Recommendations The home should review the fittings on the raised toilet (as discussed with the Registered Manager) to ensure the fittings are kept clean and do not spoil the overall look of the facility. The home should ensure that where raised seats are permanent, old seats should be either discarded or properly stored away. The home should consider more discreet labelling and storage arrangements for gloves/aprons/bags etc in toilets and bathrooms as the current labelling spoils the otherwise homely appearance of these areas. The home should review the timescales for carrying out the work to replace the old lift. Though the current lift is still working, several comments were received on the frequency with which it breaks down. The work on other refurbishments/renewals in the home is dependent on the
H58-H09 S13762 Ridgegate V239100 160805 Stage 4.doc Version 1.40 Page 24 2. OP19 Ridgegate the lift project being completed. Unfortunately,in the interim, the overall homely and attractive ambience of Ridgegate is being put at risk. Ridgegate H58-H09 S13762 Ridgegate V239100 160805 Stage 4.doc Version 1.40 Page 25 Commission for Social Care Inspection The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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