Inspection on 09/01/07 for Ridgeway

This inspection was carried out on 9th January 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Ridgeway 29/11/07

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 Elaine Boismier Key Announced Inspection 9th January 2007 9:50 Ridgeway DS0000067815.V319559.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.V319559.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.V319559.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 Mr Gary Dobson Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Ridgeway DS0000067815.V319559.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection NONE 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. Although this is the first inspection of the home copies of inspection reports should be available at the home or via the CSCI website. Ridgeway DS0000067815.V319559.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the first assessment and inspection of Ridgeway against the National Minimum Standards and Care Homes Regulations 2001 following the registration of the home on 17th July 2006. The inspection was announced and carried out between 9:50 and 13:00 and took just over 3 hours to complete. On the day of the inspection there were 5 residents living at the home and 4 of these were spoken to. The Manager and staff were also spoken to, a tour of the premises was made and documentation was examined. Six residents’ surveys were sent out and 3 of these were returned. Information provided by the Manager prior to the inspection and comments included in the residents’ surveys has been used as part of the inspection and reference to this information is made in this inspection report. The number of requirements and recommendations should fall after the home has taken action to meet these requirements and consider these recommendations by the time of the next inspection of the care home. Ridgeway provides a good standard of care and is generally a well managed service that has the potential to become that of an excellent standard should the home take action to meet any requirements and consider any recommendations within this report. Any improvements that have been made are to be sustained to achieve such an excellent standard rating. What the service does well: What has improved since the last inspection? As part of the registration process a site visit/inspection was carried out on 10th July 2006. During this inspection it was noted that access to the fuse box was unsafe. Satisfactory action has been taken to ensure the safety of people whilst accessing the fuse box. Ridgeway DS0000067815.V319559.R01.S.doc Version 5.2 Page 6 In addition to the above it was also noted that PAT tests and information signs for the hazardous substance cupboard and sings for fire and first aid were to be put in place. Satisfactory action has been taken in response to these findings. 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. The summary of this inspection report can be made available in other formats on request. Ridgeway DS0000067815.V319559.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.V319559.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): 1&2 Quality in this outcome area is good. Prospective residents have a good standard of information about the home to assist them in their decision where to live. This judgement has been made using available evidence including a visit to this service. EVIDENCE: As part of the registration process a Statement of Purpose was submitted with the application. This document contains the required information to enable prospective residents to assist in their decision where to live. Two residents’ care files were examined and both of these files contained preadmission information about the needs of the residents. Respondents of the residents’ surveys stated that they had enough information about the home before they moved in. Ridgeway DS0000067815.V319559.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. Residents receive the support in how to live their life based on risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Two residents’ care files were examined and these files contained detailed risk assessments and care plan guidance for staff in how to meet the assessed needs of the residents. There was evidence that the residents are actively involved in how they wish to live and this was confirmed by residents and during observation of staff interaction with the residents. All residents’ surveys indicated that the respondents felt that they were able to live their lives how they chose to. Ridgeway DS0000067815.V319559.R01.S.doc Version 5.2 Page 10 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): 11,12, 13, 14, 15 & 17 Quality in this outcome area is good. Residents live a good quality of life. This judgement has been made using available evidence including a visit to this service. EVIDENCE: One of the residents’ surveys reported that staff did not support the respondent sufficiently to assist in developing their independent living skills. Staff, however, including the Manager indicated that independent living tasks, such as laundry, gardening, shopping and food preparation, are encouraged as much as possible and this is an area for future development following the settling in period of residents. On the day of the inspection staff were supporting residents in going out to the local library and shops. Residents are able to access adult educational programmes. Currently a resident attends a local college one day per week. Ridgeway DS0000067815.V319559.R01.S.doc Version 5.2 Page 11 During the tour of the premises photographs were seen of events that residents have attended including a visit to a pantomime. Discussion with staff and residents indicated that residents have access to the local library. On the day of the inspection 2 residents, with the support of staff, visited the library. Residents confirmed this was a weekly activity. According to the Manager some residents, also with the support from staff, visit the village post office where residents are welcomed by the post office staff. Residents, with families, confirmed that they receive visits from family members. According to the Manager residents have some links with residents living in other care homes, based in the same locality, that belong to the registered provider. Photographs and records in 2 of the residents’ care files indicated that residents have access to a range of leisure pursuits including visits to the local town, garden centres and leisure halls. The home has two pet rabbits; photographs of residents holding these pets were seen. Information provided by the Manager before the inspection contained a copy of a 2-week menu that shows residents are offered 4 meals per day. On of the residents’ surveys stated that the respondent would like to be involved more in food preparation although staff reported that although this is encouraged not all residents are willing to participate. Minutes of residents’ meetings were seen and these included residents’ views and their likes and dislikes about the food provided. Ridgeway DS0000067815.V319559.R01.S.doc Version 5.2 Page 12 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 adequate. Residents receive an adequate standard of personal and healthcare that could be improved upon. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents said that they were treated well by staff. Residents’ care files that were examined indicated that residents were able to get out of and go to bed when they chose to do so. Residents were noted to wear clothes appropriate to their age and choice. The Statement of Purpose, and information provided by the Manager prior to the inspection, notes that residents have access to a range of health care services. These services include GPs, opticians, dentists, a Consultant Psychiatrist and Consultant Psychologist. In August 2006 the Commission received information from the home that records what action was taken when a resident became unwell. A Registered Mental Nurse and a Registered Ridgeway DS0000067815.V319559.R01.S.doc Version 5.2 Page 13 Medical Officer were accessed by the home to provide specialist assessments and appropriate management of the unwell resident. Examination of two residents’ care files indicated that residents have had access also to GPs, chiropodists and dentists. During the site inspection of 10th July 2006 it was reported that staff were to undertake training in safe practices of medication. Examination of 3 staff training files, and discussion with the Manager, indicated that staff responsible for administration of medication have attended training in medication. Medication records were examined and there were some omissions of recording. Discussion with the Manager indicated also that some medication had not been given as the stock of medication had run out. In addition the trolley, for the purpose of storage and administration of medication, was not secured to an immovable structure. This trolley was located in the Manager’s unlocked office. Two requirements have been made about these findings. Ridgeway DS0000067815.V319559.R01.S.doc Version 5.2 Page 14 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: Information provided by the Manager before the inspection notes that no complaints have been made against the home. The Commission has also not received any complaints. All 3 of the respondents of the residents’ survey stated that they knew what to do if they wanted to make a complaint. All 3 respondents of the residents’ survey considered that they were treated well by the staff of the home. All 4 residents that were spoken to said that they were treated well by staff and this was also noted during observation of staff interacting with the residents. Three staff training files that were examined indicated that these people had attended training in adult protection procedures. The Manager stated that arrangements have been made for all staff to attend such training. Copies of Regulation 26 visit reports notes that audits of residents’ personal monies are often carried out and no discrepancies have been noted during these audits. Ridgeway DS0000067815.V319559.R01.S.doc Version 5.2 Page 15 According to the Manager and 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.V319559.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, 28 & 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: Ridgeway is a two-storey converted domestic dwelling located on the edge of the village of Newton. On 10th July 2006 a site inspection was carried out as part of the registration process. Access to the fuse box was considered unsafe. It was also noted that PAT tests and information signs with regards to hazardous substances, fire and first aid were not available. During this inspection it was noted that satisfactory action had been taken in response to these findings. Ridgeway DS0000067815.V319559.R01.S.doc Version 5.2 Page 17 During the tour of the premises it was noted that one of the bedrooms had an area of damp on the external facing wall and some carpet areas were heavily stained. A requirement has been made about this. The home presents a homely feel and has generally well-maintained garden areas, including a summer house, an outside shed for people who wish to smoke. There is also a range of garden areas, including a tennis court. All 3 respondents of the residents’ survey stated that the home was always fresh and clean. On the day of the inspection there were no offensive odours. Ridgeway DS0000067815.V319559.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 Quality in this outcome area is adequate. Staff recruitment and staff training is adequate and could be improved upon. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home employs 14 members of care staff of which 5 have NVQ level 2 i.e. 35.7 . A recommendation has been made for the home to have 50 care staff with this level of qualification. Three staff files were examined and the majority of required information about the staff was available with the exception of the following: 1.There was no written explanation of a gap in employment history of a member of staff. This gap was between July 2005 and July 2006. 2.There was no photograph for one member of staff. 3.There was no clear photograph for another member of staff. Ridgeway DS0000067815.V319559.R01.S.doc Version 5.2 Page 19 A requirement has been made about this. Discussions with staff and examination of 3 staff training files indicates that staff attend training in managing challenging behaviours, diabetes and administration of medication, including the administration of insulin. Ridgeway DS0000067815.V319559.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): Quality in this outcome area is good. 37, 39 & 42 Residents live in a generally well-managed home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: An application to register the Home Manager was approved in July 2006. He has a range of managerial skills and has previously worked with children and also has worked as a volunteer with people. He completed a course in Health and Social Care studies, in 2006, and is considering applying to undertake the Registered Managers Award. A recommendation has been made that the home should be managed by a person with the Registered Managers Award. Ridgeway DS0000067815.V319559.R01.S.doc Version 5.2 Page 21 Minutes of residents’ meetings were seen and these detailed the views of residents about the running of the home, including meals and activities. Copies of Regulation 26 visit reports were seen and this contained audits of the home environment and risk assessments for residents. Residents views were sought during these visits and were recorded within the reports. Discussion with the Manager indicates that ongoing reviews are carried out of residents and these reviews were recorded in those residents’ care files that were examined. As part of the application to register the service, copies of certificates were received for electrical installation and fire safety of the building. Records for hot water checks, fire alarm tests, fire drills, emergency lighting and PAT tests were examined and these were satisfactory. Discussion with staff and examination of staff training files indicated that staff have attended training in food hygiene, moving and handling, emergency first aid and fire training. Ridgeway DS0000067815.V319559.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 3 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 3 ENVIRONMENT Standard No Score 24 2 25 x 26 x 27 x 28 3 29 x 30 3 STAFFING Standard No Score 31 x 32 2 33 x 34 2 35 3 36 x 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 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 2 x 3 x x 3 x Ridgeway DS0000067815.V319559.R01.S.doc Version 5.2 Page 23 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 YA20 Regulation 13(2) Requirement Timescale for action 17/01/07 2. 3. YA20 YA24 12(1)(a) 23(2)(a) 4. YA34 19 The Registered Person must ensure that accurate records are maintained and medication is stored safely. The Registered Person must 17/01/07 ensure that mediation is supplied in sufficient quantities. The Registered Person must 01/04/07 ensure that the home is maintained both externally and internally. The Registered Person must 17/01/07 ensure that full and satisfactory information is obtained about staff before they commence employment. 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. Ridgeway Refer to Standard YA32 YA37 Good Practice Recommendations The home should have 50 care staff with NVQ level 2 in care. The home should be managed by a person with the DS0000067815.V319559.R01.S.doc Version 5.2 Page 24 Registered Managers Award. Ridgeway DS0000067815.V319559.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Cambridgeshire & Peterborough Area Office 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. 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