CARE HOMES FOR OLDER PEOPLE
Ridgemount Ridgemount The Horseshoe Banstead Surrey SM7 2BQ Lead Inspector
Graham Cheney Announced Inspection 7th November 2005 10:15 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 Ridgemount DS0000040824.V266197.R01.S.doc Version 5.0 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. Ridgemount DS0000040824.V266197.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Ridgemount Address Ridgemount The Horseshoe Banstead Surrey SM7 2BQ 0207 759 9100 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) Anchor Trust Mrs Jean Louisa Williamson Care Home 64 Category(ies) of Dementia - over 65 years of age (28), Learning registration, with number disability over 65 years of age (2), Mental of places Disorder, excluding learning disability or dementia - over 65 years of age (20), Old age, not falling within any other category (60), Physical disability over 65 years of age (8), Sensory Impairment over 65 years of age (2) Ridgemount DS0000040824.V266197.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 31st May 2005 Brief Description of the Service: Ridgemount is a Care Home, situated in Banstead, offering accommodation for sixty four service users. The registered provider is Anchor Trust. The home is newly built and the accommodation is set over two floors and comprises of five wings, with twelve bedrooms in each, plus a small unit with four bedrooms. Each of the five wings has its own kitchen, dining room and lounge. The bedrooms all have en-suite toilet and wash hand basin facilities and each wing has a bathroom, shower room and extra toilet. The home is set in its own grounds and all areas are accessible to the service users. Ridgemount DS0000040824.V266197.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the second inspection of Ridgemount in the CSCI year 2005/2006. It was an announced inspection, which meant that residents and staff knew that it was to take place. The inspection started at 10.15 a.m. Since the last inspection there has been a change of manager with Jeanette Norman taking post in July 2005. The details above will be changed once Mrs Norman has been registered by CSCI. The inspector spent time with the manager and deputy Mr Kyle Ingram to start with, and then did a tour of the home and spending time talking with residents, staff and visitors to the home. The rest of the time was taken looking at care plans, staffing arrangements and other documents and records. Comment cards were sent out to relatives, visitors and professionals attending the home. A large number of these were returned providing the inspector with an insight into how those people saw the home. Residents and staff made the inspector very welcome and were happy to talk about life at Ridgemount. What the service does well:
Most of the residents who spoke to the inspectors were happy with the service provided. They said that they found the staff kind and helpful. Having consistent staff assigned to each unit of the home helped this. The inspector spent time on the top floor and found clear indications that staff on duty knew the residents well and a close and respectful relationship had been established. Comment cards returned were very positive towards the staffing and management of the home, describing the staff as kind, friendly and supportive. A staff training programme has been developed giving all staff training opportunities and undertake NVQs. Staff files indicated that sound recruitment procedures were operated. Residents said that they generally enjoyed the food and some explained that they were offered a choice of meals and could talk with the chef if they had any concerns. In the main they felt in control of their lives, but some found it difficult being reliant on others for support and going out. Some of the residents and relatives said they would like the option of more activities and this had been
Ridgemount DS0000040824.V266197.R01.S.doc Version 5.0 Page 6 recognised by the staff and management. Recent staff roters indicated that an activities person was working 30 hours a week to provide such support. The manager stated that the activities person had consulted all of the residents to find out what they liked to do, their interests and hobbies so that activities could be geared to suit them. All of the residents said they liked their rooms and especially having their own toilet. Some however did not feel it was as good as being in their own home, although many said they enjoyed having the company of others. The home was observed to be well presented, clean and tidy, comment cards confirmed that the home was always clean when relatives visited. There was one concern about the floor being uneven in an en-suite toilet, which management were asked to look into and report to CSCI any action to be taken. The home does not take emergencies admissions and all new residents were offered the opportunity of visiting for a day and night if they wished, to see whether they liked the home and consider whether their needs could be met. What has improved since the last inspection? What they could do better:
Ridgemount DS0000040824.V266197.R01.S.doc Version 5.0 Page 7 Medication administration records were generally well maintained. However an error appeared to have been made with one record where staff had signed to confirm that medication had been given, although the doses remained in the blister pack. It was a requirement that this be investigated and that action be taken to remind staff that medication records must be accurately maintained at all times. 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. Ridgemount DS0000040824.V266197.R01.S.doc Version 5.0 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 Ridgemount DS0000040824.V266197.R01.S.doc Version 5.0 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): 1, 3, 4, 5 Evidence gathered on this inspection confirmed that each of the assessed standards was being met. This meant that prospective residents and their relatives were provided with good level of information to help them decide if the home was suitable for them. EVIDENCE: The home’s service user guide has been revised and updated to provide prospective residents with all the required information about the home. The home does not take emergencies admissions and all new residents were offered the opportunity of visiting for a day and night if they wished, to see whether they liked the home and consider whether their needs could be met. Appropriate pre admission assessments were undertaken and provided a good level of information when the resident was admitted. Ridgemount DS0000040824.V266197.R01.S.doc Version 5.0 Page 10 Ridgemount DS0000040824.V266197.R01.S.doc Version 5.0 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, 9 Evidence gathered from a review of care plans indicated that NMS 7 was being met. NMS 9 was not fully met due to an error in one of the residents’ medication records. Although the shortcomings were minor, these must be addressed to ensure that residents’ needs can be consistently met. EVIDENCE: Medication administration records were generally well maintained. However an error appeared to have been made with one record where staff had signed to confirm that medication had been given, although the doses remained in the blister pack. It was a requirement that this be investigated and that action be taken to remind staff that medication records must be accurately maintained at all times. Medication stocks and records were sampled and showed that the majority of service users were receiving their medication as intended by their doctors. Medication was stored securely for the protection of service users. The home has care plans in place which provide details of each resident’s needs and wishes, those sampled had been kept up to date.
Ridgemount DS0000040824.V266197.R01.S.doc Version 5.0 Page 12 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 evidence gathered indicated that these standards were fully met and therefore the home was supporting residents to maintain control and autonomy over their lives as far as they were able. EVIDENCE: Most of the residents who spoke to the inspectors were happy with the service provided. They said that they found the staff kind and helpful. Having consistent staff assigned to each unit of the home helped this. The inspector spent time on the top floor and found clear indications that staff on duty knew the residents well and a close and respectful relationship had been established. In the main residents felt in control of their lives, but some found it difficult being reliant on others for support and going out. Some of the residents and relatives said they would like the option of more activities and this had been recognised by the staff and management. Recent staff roters indicated that an activities person was working 30 hours a week to provide such support. The manager stated that the activities person had consulted all of the residents to find out what they liked to do, their interests and hobbies so that activities could be geared to suit them. Ridgemount DS0000040824.V266197.R01.S.doc Version 5.0 Page 13 Residents said that they generally enjoyed the food and some explained that they were offered a choice of meals and could talk with the chef if they had any concerns or particular wishes. Ridgemount DS0000040824.V266197.R01.S.doc Version 5.0 Page 14 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): Not assessed on this occasion. EVIDENCE: Ridgemount DS0000040824.V266197.R01.S.doc Version 5.0 Page 15 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, 20, 21, 23, 24, 25, 26 Being a relatively new and purpose built home these standards were not considered to be of high priority on this occasion. On that basis all of the assessed standards were met. The home provides a high standard of accommodation for its residents. EVIDENCE: All of the residents said they liked their rooms and especially having their own toilet. Some however did not feel it was as good as being in their own home, although many said they enjoyed having the company of others. The home was observed to be well presented, clean and tidy, comment cards confirmed that the home was always clean when relatives visited. There was one concern about the floor being uneven in an en-suite toilet, which management were asked to look into and report to CSCI any action to be taken. Ridgemount DS0000040824.V266197.R01.S.doc Version 5.0 Page 16 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 evidence gathered indicated that these standards were being met. This meant that residents were being well supported and cared for and that there was a good relationship between residents and staff. EVIDENCE: Most of the residents who spoke to the inspectors were happy with the service provided. They said that they found the staff kind and helpful. Having consistent staff assigned to each unit of the home helped this. The inspector spent time on the top floor and found clear indications that staff on duty knew the residents well and a close and respectful relationship had been established. Comment cards returned were very positive towards the staffing and management of the home, describing the staff as kind, friendly and supportive. The home has not used agency staffing in recent times and indications were that the use of temporary (superbank) staff overall had been dramatically decreased from 400 to 200 hours per week. This meant that residents were attended by familiar staff who got to them well and provided a consistent level of care. A staff training programme has bee developed giving all staff training opportunities and undertake NVQs. Staff files indicated that sound recruitment procedures were operated.
Ridgemount DS0000040824.V266197.R01.S.doc Version 5.0 Page 17 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, 32, 33 The evidence gathered indicated that these standards were being met. Despite only being recently established the home’s management team appeared to be working effectively towards the ongoing improvement of the service. EVIDENCE: Since the last inspection there has been a change of manager with Jeanette Norman taking post in July 2005. The details above will be changed once the Mrs Norman is registered by CSCI. Findings on this inspection indicated that, although early days, the new management team presented a very positive approach. A good level of improvement has been made, with the requirements of the last inspection having been met. Residents and regular staff said that the home was running well and they felt they were being listened to and supported.
Ridgemount DS0000040824.V266197.R01.S.doc Version 5.0 Page 18 Ridgemount DS0000040824.V266197.R01.S.doc Version 5.0 Page 19 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 3 X 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 X 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 3 3 3 3 3 3 3 3 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 3 3 3 X X X X X Ridgemount DS0000040824.V266197.R01.S.doc Version 5.0 Page 20 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 OP9 Regulation 13(2) Requirement It was a requirement that error identified on a medication record be investigated and that action be taken to remind staff that medication records must be accurately maintained at all times. Timescale for action 07/11/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Ridgemount DS0000040824.V266197.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Surrey Area Office 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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