Inspection on 29/11/07 for Ridgeway

This inspection was carried out on 29th November 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 11 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Ridgeway 09/01/07

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Ridgeway Chapel Lane Newton Wisbech Cambridgeshire PE13 5EU Lead Inspector Joanne Pawson Unannounced Inspection 29th November 2007 10:30 Ridgeway DS0000067815.V356093.R01.S.doc Version 5.2 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 Ridgeway DS0000067815.V356093.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 Adults 18-65. 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. Ridgeway DS0000067815.V356093.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ridgeway Address Chapel Lane Newton Wisbech Cambridgeshire PE13 5EU 01945 870904 01945 870953 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) Ermine Care Ltd vacant post Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Ridgeway DS0000067815.V356093.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 9th January 2007 Brief Description of the Service: Ridgeway is located on the edge of the village of Newton that is located approximately 3 miles for the Cambridgeshire market town of Wisbech. The village of Newton has a post office/store, public house and a church. All of the shops, recreational, leisure facilities and other amenities can be found in Wisbech. Private transport is available to access the community. Ridgeway is a converted two-storey domestic dwelling that has up to a maximum of 6 places for people under 65 years of age with a learning disability and mental health needs. All bedrooms are of single occupancy and are provided with ensuite facilities. The home has a lounge, a dining area and a conservatory. Gardens are mainly to the rear that includes a tennis court, patio areas, lawns and fruit and vegetable patches. Fees range from £1600 to £1800 per week. Additional costs include those for chiropody, massage and haircuts. Copies of inspection reports should be available at the home or via the CSCI website. Ridgeway DS0000067815.V356093.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out from 10.30am until 5pm on the 29th November 2007. We (the commission) spent time with the residents and had a look at their bedrooms when invited to do so. We also spent time with a senior support worker looking at policies, documents and care plans. What the service does well: What has improved since the last inspection? 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 Ridgeway DS0000067815.V356093.R01.S.doc Version 5.2 Page 6 contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Ridgeway DS0000067815.V356093.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Ridgeway DS0000067815.V356093.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area good. Residents’ needs are assessed before moving into the home to ensure their needs can be met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The pre admission assessments for the residents was inspected during the last inspection and were found to be satisfactory. Ridgeway DS0000067815.V356093.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9, Quality in this outcome area is good. Staff have the information they need to meet the needs of the residents’. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Two care plans were inspected. They contained detailed information on mobility, self harming, self discipline, routines, personal hygiene, physical interventions, personal fitness, diet, socialisation and activities, finances, diagnosed conditions, choking and communication. The care plans were written in a positive and encouraging manner such as ‘remind resident that he is a good person who is liked by others’ when he was at risk of self harming. The care plans were last reviewed in August 2007 but there was evidence that they had been updated when needed. The residents were aware of and had signed their care plans. Ridgeway DS0000067815.V356093.R01.S.doc Version 5.2 Page 10 The personal care care plan needs to be more detailed so that staff are aware what the residents can do for themselves and what they need encouragement and help to do this will help to promote their independence. One care plan stated that staff should provide the resident with daily opportunities to access the community and integrated with local people and places. The residents had gone shopping on the day of the inspection. The communication care plan for one resident was good in that it stated ‘may tell slightly elaborated tales but may choose disclose very significant truths amongst this’. The health action plan for one resident stated that he used sign language however his communication care plan did not refer to any sign language being used. Ridgeway DS0000067815.V356093.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15,16,17 Quality in this outcome area is good. Residents take part in a wide variety of leisure activities. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents take part in a wide variety of leisure activities. Regular scheduled visits include local shops, community library, leisure centre sessions, local pubs & restaurants, college, church and village post office (where service users have an excellent relationship with the local sub-postmistress). In addition, fortnightly seesions are held at Ridgeway for music participation (local musician) and also for massage therapy (local masseuse), a mobile hairdresser also visits regularly . One day each week is set aside for day-excursions, these have recently included visits to Woburn Abbey, Hemsby/Yarmouth, Leicester Horseracing, Skegness, Dymchurch/Canterbury, Sheringham Fun Splash leisure pool and numerous animal-based venues. Ridgeway DS0000067815.V356093.R01.S.doc Version 5.2 Page 12 The residents were out with staff getting new tyres on the car on the day of the inspection. One resident stated that he had not been able to go to the gym the previous day as there had not been enough staff on shift. One resident stated that he did not want what was on the menu for tea. When I encouraged the resident to tell the staff this at first they said it was to late as it was already being cooked. After a discussion with the resident they offered him a cold alternative but said there was nothing else that could be cooked. Residents should be encouraged to make choices about the food they eat and at what time. There should be a stock of alternative food available so that if a resident does not want what is on the menu they can choose something else. The senior carer stated that the menu is planned taking into consideration the likes and dislikes of the residents. The pre inspection information for the home stated family members, friends and other visitors are always welcomed at Ridgeway. Ridgeway DS0000067815.V356093.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Quality in this outcome area is poor. Residents’ are not always receiving the care and support they need. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home now uses the Boot’s Monitored Dosage System for the administration of medication. All staff have received training in the administration of medication but is only the senior support workers who administer medication. There were various omissions for the signing of the administration of medication. One entry stated that the medication had not been given as no medication was delivered. One resident has been prescribed a sleeping tablet. However if he cannot sleep after 1am he is not allowed to have the tablet even if he asks for it. This has caused him on occasions to become aggressive with the staff member refusing to give him the tablet. The explanation for not allowing him the tablet was because it would make him sleepy the next morning. The resident’s rights Ridgeway DS0000067815.V356093.R01.S.doc Version 5.2 Page 14 according to the Mental Capacity Act must be explored and any restrictions must be recorded in his care plan. There is no record of what medication has been received so it was not possible to complete a medication audit to see if the number of signatures of medication administered matched the number of remaining tablets. Risk assessments for PRN medication for the control of unacceptable behaviour must be detailed. One risk assessment stated ‘PRN medication is to be used as required to assist in the management of the residents’ behaviour’. One resident is prescribed rectal diazepam. The administration of this must be delegated from the district nurse and the appropriate training completed. No staff have received training in the administration of rectal diazepam. There was also no delegation of nursing task forms for the administration of insulin. An immediate requirement was issued that stated if delegated nursing tasks must only be undertaken after receiving the appropriate authorisation and training. There has been no competency testing of the staff administering the medication since their initial training in July 2006. The weight chart for one resident showed that he had been weighed monthly until July 2007 and then had not been weighed since. The medical appointments form showed that the same resident had last seen a dentist in November 2006 and an optician in September 2006. The staff working on the day of the inspection stated that new appointments have been booked but they had not been written into the medical appointments form. Evidence showed that GP’s were seen when necessary. The staff on shift stated that one of the resident’s periods of illness had been progressing to be for longer periods of time. However no specialist support had been requested to see if anything could be done to support the resident through this time. One of the residents confirmed that they get the support they need with personal care. Residents were noted to wear clothes appropriate to their age and choice. Ridgeway DS0000067815.V356093.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is good. Residents are safe and protected from harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The pre inspection information stated that the home has robust policies dealing with the management of complaints from service users, staff, families and other agencies. There are set guidelines, timelines and deadlines in place to manage the complaints process and that the home had not received any complaints during the last twelve months. The home has a whistle blowing policy which staff can use if they think a resident has been abused in anyway. Not all staff have received training in the protection of vulnerable adults. The senior member of staff on shift was aware what actions to follow if she suspected a resident had been abused. According to the information provided in the pre-inspection questionnaire there have been no reports of abuse against any resident and the Commission has received no such allegations. Ridgeway DS0000067815.V356093.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,27,29,30 Quality in this outcome area is adequate. Residents live in a homely and generally clean place that could be improved upon. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home presents a homely feel and has generally well-maintained garden areas, including a summerhouse, an outside shed for people who wish to smoke. There is also a range of garden areas, including a tennis court. Residents’ bedrooms are very homely and reflect their individual personalities. The bath seems unsuitable for one of the residents and poses a health risk to the resident and the staff member assisting him. There must be an occupational therapy assessment of the bathing equipment and the Ridgeway DS0000067815.V356093.R01.S.doc Version 5.2 Page 17 appropriate aids purchased to ensure the health and safety of the residents and the staff. The carpet is the hallway and stairs and is very stained and must be cleaned to an acceptable level or replaced with more appropriate flooring. This was noted in the previous report and a requirement was made. Failure to meet this requirement could lead to the commission taking legal action. There is a leak in the conservatory roof which has a bucket placed under it for when it rains. This has been a problem for a number of months and must be repaired. Other than the stained carpets the home was clean and free from any offensive odours on the day of the inspection. Ridgeway DS0000067815.V356093.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35,36 Quality in this outcome area is adequate. Staff have not received the training and support they require since the manager left which means that may not have the skills necessary to meet the needs of the residents’ This judgement has been made using available evidence including a visit to this service. EVIDENCE: When I talked to some of the staff team it was clear that the morale of staff was very low. Some of the staff feel that they have been left to run the home without any support from the provider. The supervision records would support this in that no one has received supervision since the manager left in August 2007. One member of staff had not received supervision since May 2007. The manager ensured that all staff watched training videos before he left. However staff need to attend practical training for subjects such as moving and handling and first aid. Three staff files were looked at that showed that staff have received training in managing challenging behaviour, mental capacity act, moving and handling, fire prevention, health and safety, first aid, food hygiene and the administration of medication. However the majority of this training was by Ridgeway DS0000067815.V356093.R01.S.doc Version 5.2 Page 19 watching a training video on the subject. This method of training has it’s limitations as the staff member does not have an expert in the subject that they can ask questions of it they are unsure of any points. Staff spoken to during the inspection process stated that they had not received any practical training with fire extinguishers since the home opened and would feel unsure if they had to use one in an emergency. The provider must ensure that the training provided meets the needs of the staff and provides them with the information they need to meet the needs of the residents and to ensure their safety. Not all staff have received all of the mandatory training. An immediate requirement was issued to ensure that the training gaps are identified and the appropriate training courses booked. The files of three members of staff were tracked. They contained the required recruitment information. One member of staff has NVQ 2 and four are working towards it. Three members of staff have an NVQ 3. Ridgeway DS0000067815.V356093.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,41,42 Quality in this outcome area is poor. The homes policies and procedures are not being followed to ensure a safe environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager resigned from his position in August 2007. Since this time there has been no managerial support for the service. A new manager has been appointed and is due to commence work in January 2008. Money held on behalf of the residents was checked and found to be accurate. Ridgeway DS0000067815.V356093.R01.S.doc Version 5.2 Page 21 There were no records available on the day of the inspection for the testing of the hot water temperatures. The staff working on the day of the inspection were not sure if there were thermostatic control valve fitted to the hot water to prevent the risk of scalding. We tested the water by hand and it did feel quite hot. Portable appliance testing was completed in October 2007. The home has a form for the first aid kit to be checked monthly to ensure that there are sufficient supplies however the form had not been completed since September 2007. The records for the testing of the fire alarms had been completed weekly until the manager left in August 07. The only record of the testing of the fire alarms since then was when the system was serviced in October. The records show that the emergency lighting has not been tested since August 2007. This must be done monthly. There were monthly residents meetings up until the manager left. However the issue of the bath being unsuitable for one of the residents was discussed at the meeting in May and July 2007 and this is still outstanding. Health and Safety issues must be dealt with in an appropriate timescale. Service questionnaires about the quality of the service provided were completed in June 2007 however not all of the questions were relevant to the home. Ridgeway DS0000067815.V356093.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 3 26 X 27 3 28 X 29 2 30 2 STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 2 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 1 X 1 X 3 X X 1 X Ridgeway DS0000067815.V356093.R01.S.doc Version 5.2 Page 23 Yes 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 YA19 Regulatio n 13(1)(b) Requirement Residents must have access to the relevant healthcare professionals to support their assessed needs. People living in the home must receive medication as prescribed and records of medication administered must be completed accurately. Delegated Nursing tasks must only be carried out after the appropriate training and authorisation. An immediate requirement was issued. All staff must attend POVA training to ensure they have the information they need to protect the residents. The leaking roof in the conservatory must be repaired. There must be an assessment of the bathing equipment and any specialist equipment must be purchased and fitted. The stained carpets must be cleaned or replaced. Mandatory training must be booked for all staff. An immediate requirement was issued. DS0000067815.V356093.R01.S.doc Timescale for action 10/01/08 2. YA20 13(2) & 10/01/08 3. YA20 12(1)(a) 07/12/07 4. YA23 13(6) 01/03/08 5. 6. YA24 YA29 23(2)(b) 23(2)(n) 01/03/08 01/03/08 7. 8. YA30 YA35 23(2)(d) 18(1)(i) 01/02/08 15/01/08 Ridgeway Version 5.2 Page 24 9. 10. YA36 YA42 18(2) 23(4)(v) 11. YA42 13(4)(a) A system must be put in place for all staff to receive regular supervision There must be regular checks of the fire alarm system. An immediate requirement was issued. There must be regular checks of the temperature of the hot water to ensure risks to residents are minimised. An immediate requirement was issued. 15/01/08 07/12/07 07/12/07 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 YA17 YA32 Good Practice Recommendations An alternative to meal on the main menu should be available. The home should have 50 care staff with NVQ level 2 in care. Ridgeway DS0000067815.V356093.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Inspection Team CPC1 Capital Park Fulbourn Cambridge CB21 5XE 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. Extracts may not be used or reproduced without the express permission of CSCI Ridgeway DS0000067815.V356093.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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