Inspection on 27/11/07 for Ridgeway House

This inspection was carried out on 27th November 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Ridgeway House 21/02/07

Ridgeway House 16/11/05

Ridgeway House 20/06/05

Ridgeway House 01/12/04

Ridgeway House 10/06/04

Ridgeway House 20/01/04

Similar services:

2 Perhaver Park

The Vicarage

Fairfields Country Rest Home

St George`s

5 Seafield Road

Credence House

Poldhu

Queensmount

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

CARE HOMES FOR OLDER PEOPLE Ridgeway House The Lawns Wootton Bassett Wiltshire SN4 7AN Lead Inspector Sally Walker Unannounced Inspection 09:20 27 November 2007 th 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 Ridgeway House DS0000028401.V352914.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 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. Ridgeway House DS0000028401.V352914.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ridgeway House Address The Lawns Wootton Bassett Wiltshire SN4 7AN 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) 01793 852521 01793 849354 manager.ridgewayhouse@osjctwilts.co.uk www.osjct.co.uk The Orders Of St John Care Trust Miss Eleanor Joan Walton Care Home 43 Category(ies) of Dementia - over 65 years of age (10), Learning registration, with number disability (1), Old age, not falling within any of places other category (33) Ridgeway House DS0000028401.V352914.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Only the one named female service user under the category of LD, as requested, in the application dated 24 November 2005. 21st February 2007 Date of last inspection Brief Description of the Service: Ridgeway House is a purpose-built residential home for 42 older people, some of whom may have dementia. Built in the 1970’s, the home was formerly owned and run by the local authority, but has for some years been provided by the Orders of St John Care Trust. It is one of a number of homes provided by them in Wiltshire and elsewhere. Accommodation is all in single rooms, located on two floors, with a passenger lift to the first floor. All bedrooms have wash hand basins, and one has en-suite facilities. Toilets and bathrooms are located conveniently. There are sitting rooms on each floor, whilst behind the home are secure gardens, including a landscaped patio area. The dining room overlooks the gardens. The home is located in a residential area a short walk from Wootton Bassett town centre, where shopping and social facilities are available. There are good bus links to neighbouring towns, whilst the home has its own car park in front of the main entrance. The staffing levels are 5 care staff and a care leader during the weekday mornings. There is one care leader and 4 care staff during the afternoons and evenings. This drops at the weekends to one care leader and 4 care staff during the mornings and one care leader and 3 staff during the afternoons and evenings. There are 3 waking night staff throughout the week. Details of current weekly fees can be obtained directly from the home. Ridgeway House DS0000028401.V352914.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 2 days. On 27th November 2007 between 9.20am and 5.40pm and on 29th November 2007 between 9.25am and 5.40pm. Miss Walton was present during both days. Mr Colin Titcombe, Operations Manager, The Orders of St John Care Trust, was present for the feedback. We spoke with 5 residents, 4 staff and a visiting district nurse. As part of the inspection process survey forms were sent to the home for distribution to the residents, relatives, care managers, healthcare professionals and GPs. Comments can be found in the relevant section of this report. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. What the service does well: As much information as possible is gained about prospective residents care and social needs before decisions are made about whether the home can meet those needs. The care needs of current residents are also taken into account at the time. Care plans are generally comprehensive with good detail about residents personal and social care needs. Consideration of residents’ individual wishes is taken into account when providing intimate personal care by staff of a different gender. Although the records did not always reflect this, care staff are very knowledgeable about individual care and support needs. Residents have good access to healthcare professionals and any concerns are promptly referred. Staff have a good understanding of care and support for residents who may be dying. Families are supported during this time. Miss Walton and some staff have trained in end of life care. Residents can administer their own medication following a risk assessment. Systems are in place to ensure safe administration of medication. Medication is regularly reviewed. Residents are encouraged to continue to do the things they were doing when they lived in their own homes. Risk assessments do not restrict residents from going out on their own. Those residents who can choose follow their own routines. Residents are encouraged to decide for themselves about their daily lives. Ridgeway House DS0000028401.V352914.R01.S.doc Version 5.2 Page 6 Residents enjoy the quality, choice and quality of the meals. All meals are cooked from fresh ingredients. Each course has two choices. Snacks and refreshments are provided for all visitors. Miss Walton takes complaints seriously. She makes sure that complainants know the outcome of her investigations and any action taken to address matters. Residents know that they can approach Miss Walton to raise concerns. Staff are confident in reporting any allegations of abuse to the Safeguarding Adults process. A robust recruitment procedure is in place. No one starts work without a check on the Protection of Vulnerable Adults list to establish that they are suitable to work with vulnerable people. Staff engage with residents and good relationships are established. Staff are experienced and well trained. All staff have access to training. Miss Walton ensures that the home is run in the best interests of the residents. She is well known to residents. All of the requirements of the last inspection of 21st February 2007 have been actioned. What has improved since the last inspection? Miss Walton has successfully improved standards in the home following its time without a permanent manager. Members of staff are to take the lead on tissue viability and dementia. Training had taken place with the Tissue Viability Specialist Nurse. New formats had been provided by the organisation to assess each resident’s risk of developing pressure damage. Activities are part of the care plan. An activities co-ordinator has been appointed. Residents had been consulted about the provision of activities as part of the quality assurance. Many said they did not necessarily want to be involved with group activities, games or competitions. So consideration is given to other activities which residents could do like cooking. The Alzheimers Society had provided training on activities to family as well as staff. The organisation sought funding and has provided a computer with internet access that can be used anywhere in the building. Residents and staff were to be trained in how to use it. It will enable some residents to keep in touch with family by email. Significant refurbishment is underway to replace and refurbish the bathrooms, toilets and sluices. Much of the rest of the home has undergone redecoration with new carpets, windows and doors installed. A programme is in place to continue with the refurbishments. Ridgeway House DS0000028401.V352914.R01.S.doc Version 5.2 Page 7 Regular staff supervision is now in place. 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 House DS0000028401.V352914.R01.S.doc Version 5.2 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 Ridgeway House DS0000028401.V352914.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3. Standard 6 does not apply as no intermediate care is provided. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ experience of the admission process was positive. The home ensures that they know as much as possible about people before they decide whether needs can be met. EVIDENCE: The organisation’s new pre-admission assessment form is lengthy and provides little space for capturing details of all potential resident’s care and support needs. Much of the format relates to nursing care and takes the form of a tick list. However staff had gathered further information about residents’ often complex care needs on the back of the forms. Detailed care management assessments had been obtained together with information from hospital staff or consultants. Miss Walton ensures that full assessments are carried out if a resident spends any time in hospital to make sure that the home can continue Ridgeway House DS0000028401.V352914.R01.S.doc Version 5.2 Page 10 to meet their needs. Miss Walton said that during the assessment process, the needs of the other residents are taken into account. One of the residents told us about their experience of admission to the home. They had used the respite service in the past and felt that moving to the home had been a positive experience. Ridgeway House DS0000028401.V352914.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 & 11 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans generally set out good details on how needs are to be met and monitored. The home relies on healthcare professionals’ records with some aspects of care without keeping their own records. Residents have good access to healthcare support. Residents can administer their own medication. Systems are in place to ensure safe management of medication. Staff respect residents privacy and dignity. Residents who may be dying are treated sensitively and good end of life care is provided. Families are supported through this time. EVIDENCE: Care plans were being transferred into the organisation’s new care planning format. This format had many sections relating to nursing care. Information about residents’ social as well as medical history were assimilated into the care plans. We advised that care should be taken to ensure that all the information Ridgeway House DS0000028401.V352914.R01.S.doc Version 5.2 Page 12 in the current format is transferred to the new. The old format of care planning was very detailed and captured all aspects of residents care and support needs. Guidance on how those needs were to be met was generally very detailed and it was evident that care plans were regularly reviewed. However some information in the daily reports had not been reviewed as part of the care plan. One resident was described as ‘verbally aggressive’. There was no indication as to what this meant or how it should be managed. One of the new care planning formats detailed information about how the care was to be provided in the assessment section rather than the intervention section. One resident was prescribed a medication for the treatment of diabetes. However their care plan made no mention of how their condition was being managed or monitored. It was clear from talking to the care leader that an action plan was in place in consultation with the GP. We talked about the need to record all these aspects of residents care. There was good evidence that staff took into consideration residents preferred routines for personal care giving. Residents were asked for their views about intimate personal care giving from a member of staff of a different gender. This was noted on their care plan. We advised that the bathing risk assessments must identify whether the resident is ever left to bathe alone and for how long. It was clear that staff make efforts to ensure that residents are well groomed. The Tissue Viability Specialist Nurse had provided training to staff. A member of staff is to take the lead responsibility for ensuring that residents’ tissue viability is assessed and monitored where necessary. New formats had been introduced to assess residents’ nutrition and risk of developing pressure damage. Care plans identified any pressure damage but there was little detail save that the district nurse was involved with treatment and that pressure relieving equipment was in place. We advised that the home must keep their own records of treatments and interventions rather than rely on the district nursing notes kept in the home. Care records should regularly record size, colour of any wounds and whether the skin was broken, for evidence of healing. We advised that the nutritional risk assessment outcome should inform the pressure risk assessment. We also advised that the outcome number of the assessments were recorded for monitoring purposes. Residents are weighed on admission and their weight is monitored regularly afterwards. All healthcare appointments were recorded. It was evident from the daily record that any concerns were promptly reported to healthcare professionals. There was also good evidence of good staff support to residents who may be unwell or dying. There was good evidence of positive end of life care with regular input from the district nursing service. Families were supported during this time with unlimited access to the home. Ridgeway House DS0000028401.V352914.R01.S.doc Version 5.2 Page 13 Action had been taken to meet the good practice recommendation we made that keyworkers are encouraged through supervision to evaluate elements of care plans. This was to consider residents quality of life. Action had been taken to address the requirement we made at the inspection of 21st February 2007 that all care plans contain an assessment of risk of pressure damage with positive planning to reduce any identified risk. No action had been taken to address the good practice recommendation that fluid charts should show an indication of quantities of drinks taken. The file contained a list of the volumes of all the cups, mugs and glasses used in the home. However individual fluid charts were seen to record only the type of beverage rather than the amount. Consequently residents’ fluid intake could never be monitored. There was no evidence in the care plans as to how much fluid each resident should be consuming each day. It was noted that all of the residents visited in their bedrooms had jugs of juice or water within easy reach. One of the care leaders said they would undertake a review of the care of all the residents whose fluids were being monitored to establish how much they needed to consume each day. This would be put on each chart for monitoring purposes. One of the care leaders said that residents had particularly good support from the district nursing service. The Continence Service regularly monitored continence. Miss Walton said she was due to meet with all the district nurses to discuss joint working and any issues. One of the district nurses told us about the care and support skills of the staff. They said they always acted on any advice given. One of the care leaders with the delegated responsibility for the administration and control of medication explained the system. They said that a new supplier’s system was being currently trialled. It was anticipated that all the records, ordering and stock control would be computerised to minimise any risk of error. Findings of the trial were being relayed to the supplying pharmaceutical company. The medication storage had been moved to a larger room. Residents can administer their own medication following a risk assessment in consultation with their GP. This is regularly monitored. Care plans identified triggers for administration of medication that was prescribed to be taken only when necessary. There were short-term care plans for short courses of medication or topical creams. Staff can only administer medication following a period of training and assessment of competency. Competency is regularly monitored. All medication is checked and signed for as it is received from the pharmacy. Records were kept of any unused or unwanted medication returned to the pharmacy. The arrangements for administration and storage of controlled medication were satisfactory. The medication administration record was being properly completed. The organisation’s medication policy and procedure was available to staff. The medication administration record file Ridgeway House DS0000028401.V352914.R01.S.doc Version 5.2 Page 14 had guidance on what action staff must take if an error occurred. All medication was regularly reviewed with the resident’s GP. Action had been taken to address the requirement we made that the home’s medication policy is adhered to by all staff when written additions are made to the medication administration record. Actions had been taken to ensure that proper provision is made for residents to receive their full course of medication. This included consulting the GP or pharmacist as to the appropriate time to administer doses. This related to staff not giving antibiotics, as a resident was asleep. Miss Walton and three staff had recently attended training in end of life care. This is a national initiative to work positively with people who may be dying. There was evidence of this being put into practice. In a survey form one of the residents wrote: “I think the care service is very good. [What the home does well] Medical attention.” A relative wrote: “[the resident] was refusing most help at home. At Ridgeway House [the resident] has [their] self respect back and now enjoys a regular bath, neat & tidy appearance and mixing well with the other residents. [The resident] enjoys the meals there and is gaining a little weight. [The resident] is encouraged to walk with [their] zimmer when possible. The staff are very kind to [the resident]. I am very impressed by the way Ridgeway House is run.” A healthcare professional, in answer to the question does the home seek and act on advice, wrote: “I’ve always found them good.” One of the care managers wrote: “Over the five years that I have worked with clients/residents at Ridgeway House and through several managers, I have always had a good relationship, working and personal, which has placed the care needs, dignity and personal requirements at the top of their list.” Another relative wrote about raising concerns: “[the resident] needs [their] ears seeing to. But that’s a few weeks ago.” Ridgeway House DS0000028401.V352914.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are encouraged to continue to do the things they did when they were living in their own homes. Risk assessments do not restrict residents from doing these things. Residents have good contact with the local community. Those residents who can, make decisions about their daily lives. Other residents rely on staff for direction. Residents enjoyed the quality, choice and variety of the meals provided. A very good range of freshly made food is available. EVIDENCE: Residents were encouraged to follow their own routines. Those residents who could not decide relied on staff for direction. One resident said “you please yourself when you get up and go to bed.” They also said they went out when they wanted to but would have to tell staff they were going. There was evidence of decision making in care plans and daily reports. Ridgeway House DS0000028401.V352914.R01.S.doc Version 5.2 Page 16 An activities co-ordinator had been recently appointed. They work for 20 hours each week. Action had been taken to address the requirement we made that residents have a care plan detailing their needs and wishes in respect of activity and occupation. This related to some of the residents saying that they did not necessarily want to be involved in games or quizzes; rather they wanted to be occupied with something. Residents interests are recorded in care plans and the activities co-ordinator records the different events and residents involvement. All events are publicised. A monthly newsletter is published. Many of the residents go out on their own to the town centre, which is very accessible from the home. Risk assessments showed how residents were supported to continue to access the locality alone. One of the residents told us that they regularly took the bus to Swindon to go shopping. One resident said they had the security code for the front door so they could always get in and out when they wanted. Two residents continued to drive their cars. The organisation provides a good programme of competitions between homes. Some residents told us that they had been to a nearby home that week for a quiz. They said they had also been provided with refreshments. The home has a large hall for events including church services, celebrations and parties. Families are also encouraged to use the hall for parties. The hall is let out to community groups. The activities for the Christmas and New Year period were displayed on notice boards around the home. One of the residents showed us their copy of the programme. They also had a programme of that weeks activities. For 3 days there were activities planned for morning and afternoon. Some of the residents were going Christmas shopping that week in Swindon. One of the staff had set up cooking sessions. This had proved particularly successful with some residents who had a diagnosis of dementia. The member of staff had then written a paper on this piece of work. The organisation had obtained a grant to install a computer with internet access that residents could use anywhere in the building. It had recently been installed and residents and staff would be shown how to use the facility. It is intended that residents can stay in touch with family by email and video link. We re-examined the good practice recommendation we made that a policy was implemented on asking residents to contribute to the costs of certain activities. We were told in February 2007 that funding for trips was difficult and there was a reluctance to ask residents for contributions. Mr Titcombe and Miss Walton told us that the amenity fund was for activities and trips; residents did not have to pay. Ridgeway House DS0000028401.V352914.R01.S.doc Version 5.2 Page 17 The Alzheimers Society had provided training in activities. Relatives had also taken part in this training. The purpose was to support families with strategies for a good outcome and quality time when visiting their family member. All of the residents spoken with said they enjoyed the quality and variety of the food. One resident said the chef knew what their favourite meals were. They said they regularly met with the chef to discuss the menus. One resident said there was “tea on tap all the time”. There is a 5 week menu with a range of traditional dishes reflecting the tastes of older people. A cooked breakfast is provided together with cereals and toast. There are two choices of each course for each meal. All the meals are made from ‘scratch’ with fresh ingredients. The chef makes all the cakes and biscuits. The chef told us that the residents expected to be involved in making the Christmas puddings. The mixture was taken to the residents so they could stir it. The chef reported that the food budget included sherry for trifle and other treats. Special diets were catered for. The chef said they held the intermediate food hygiene certificate and was due to train in supervisory management. They had also trained in dementia care. The lunch was well presented and served according to residents’ appetites. Residents said they had a choice of 3 different juices with their meals and in their jugs in their bedrooms. Whilst talking about making a complaint, one of the residents took us to the office to tell the manager that they wanted to complain about the lateness of the meals. They said they came to the dining room at the advertised time and often had to wait for at least 10 minutes to be served. Miss Walton promised to look into the matter. The resident appeared satisfied with this. Over the two days meal starting times were observed. Meals started to be served at the expected times. Miss Walton said that staff had already started to serve at a different table each mealtime so that the same residents did not always get their meals first, with the others always being served last. One of the residents told us that refreshments, snacks and soup were available for residents and their visitors. Visitors were encouraged. In a survey form one of the residents wrote: “Good food. More outings, particularly walks in the local countryside. Short walks, occasionally. I am happy to be living here.” In a survey form one of the relatives wrote: “It meets [their] wishes, not necessarily what I regard as [their] needs eg for exercise. [My relative] has put on a lot of weight since moving to RH because [the resident] eats well but does not exercise much – apart from when I take [the resident] out somewhere for a drive or visit. Perhaps this is the inevitable result – [the resident] cannot be coerced.” Another relative wrote about things that could be improved: “I wonder whether residents could be given a choice about who to sit with for meals?”. Ridgeway House DS0000028401.V352914.R01.S.doc Version 5.2 Page 18 Another relative wrote: “They’ve been supportive in getting [the resident] able to walk round the town.” Another relative wrote: “[the resident is ] always happy with the food.” Another relative wrote: “Proves a caring service in a good environment. Welcoming to visitors (including my dog!). Good links with the wider caring community in Wootton Bassett. Offers many activities – (I wish [the resident] would take part more).” Ridgeway House DS0000028401.V352914.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Systems are in place for residents and their relatives to complain about the service. Management takes positive action when people complain. Staff are aware that abuse of any kind is not tolerated. Staff are confident in reporting any allegations. EVIDENCE: The home works to the organisation’s complaint procedure. The complaints log showed a good record of investigations, findings and action taken to address issues. There was also good evidence of this in response letters to complainants. The majority of the residents spoken with said they knew how to make a complaint. Some identified Miss Walton as the person to speak to and others mentioned the staff and the administrator. One resident said there was a suggestion box for comments. Another said there was a box for complaints. The home works to the local Safeguarding Adults policy entitled “No Secrets in Swindon and Wiltshire”. Discussions with staff showed that they were familiar with the procedure and would not hesitate to report any allegations of abuse. All staff had received regular training in the local policy and procedure. Ridgeway House DS0000028401.V352914.R01.S.doc Version 5.2 Page 20 In a survey form one of the relatives wrote: “I have never raised concerns over [the resident’s] welfare.” An undisclosed source wrote on a healthcare professionals form: “they don’t listen to complaints. If you do complain you get picked on. To make sure that the right staff to Do do [sic] the job are taken on.” Ridgeway House DS0000028401.V352914.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Significant efforts have been made since the last inspection to improve the quality and comfort of the home for residents. Work to upgrade the toilets, bathrooms and sluices is nearing completion. No unpleasant odours were detected at any time. EVIDENCE: All residents have single bedrooms, one with an ensuite facility. Bedrooms were personalised to reflect each person’s personality. Significant efforts have been made to improve the quality of the environment for residents. The dining room had recently been re-decorated and re-carpeted. The downstairs sitting room had been re-carpeted and new windows and doors fitted. New lighting had been installed in all the corridors. Mr Titcombe said that the organisation Ridgeway House DS0000028401.V352914.R01.S.doc Version 5.2 Page 22 now employed a team of professional decorators to address refurbishment in its homes. The hairdressing room was in the process of being totally refurbished. A new accessible shower had been installed in one of the upstairs bathrooms. Miss Walton said that one of the residents took a shower every morning and increasingly residents preferred a shower to a bath. She went on to say that the plan was to install another accessible shower room to the ground floor. During the inspection Miss Walton arranged for one of the bedroom windows to the first floor that did not have restricted opening for safety reasons. Miss Walton told us of her plans to gradually replace all of the chairs in the sitting rooms with new. Work was well underway to meet the requirement we made about adequate sluicing facilities being provided. This was to prevent infection, toxic conditions and the spread of infections. We asked for an action plan showing when the work would be done. Miss Walton telephoned us soon after the last inspection to say that funds had been made available to install new equipment and refurbish the rooms. We made a good practice recommendation that consideration should be given to making the bathrooms and toilets more homely. We also recommended that regular audits are carried out in the bathrooms, toilets and sluices. This was so that areas of high risk in terms of infection control are made good. Miss Walton told us that the bathrooms and toilets were in the process of being totally refurbished, with new fittings. She said their decoration and homeliness would be considered when the works were completed. All of the toilet would be wheelchair accessible. This work is well underway. Mr Titcombe agreed during this inspection that allowance would be made in this year’s budget for the back stairs to be re-carpeted by the end of March 2007. The chef told us about the plans to refurbish and redecorate the kitchen. There was a small kitchen in the community hall, which would be available during this time to allow meals to continue to be provided. Action had been taken to address the requirement we made that commode bowls were returned to the same individual resident as they were emptied and cleaned. A sterilizing machine had been installed which would reduce any risk of cross infection. Residents talked to us about the cleaning and laundry facilities. They said that their rooms were cleaned every day and laundry promptly returned. No unpleasant odours were detected at any time during this inspection. Ridgeway House DS0000028401.V352914.R01.S.doc Version 5.2 Page 23 It was difficult to establish whether our good practice recommendation to improve access to the gardens by providing walkways with even surfaces had been addressed. The accident book showed no falls occurring in the grounds. However it was the middle of November and the poor weather had restricted anyone from using the gardens. We will consider this again at the next inspection. We discussed the call bell system with residents. They all said that staff were prompt in responding at any time during the day or night. One resident said they had never had cause to use their bell. We activated it and confirmed that staff did indeed respond very promptly. In a survey form one of the relatives wrote: “Could regular visitors like myself be informed of the key code for access, in and out of the front door, to avoid long waits.” Ridgeway House DS0000028401.V352914.R01.S.doc Version 5.2 Page 24 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The care and housekeeping staffing levels are reduced at weekends. Care staff are expected to do cleaning and laundry as well as care. Staff have a wide range of experience and are well trained. A robust recruitment procedure is in place. Residents told us of their good relationships with staff. Staff engaged with residents in a positive and respectful manner. EVIDENCE: The care staffing rota was not consistent for the whole week. There was a minimum of 6 care staff and a care leader during weekday mornings and 5 care staff and a care leader during the weekday afternoons and evenings. The care staffing levels were reduced at the weekends to 5 care staff during Saturday and Sunday mornings. There are 3 waking night staff. Housekeeping staff was also reduced at weekends. Care staff were expected to carryout some cleaning and laundry duties when these area were not covered by specific staff. Miss Walton said that a care support post would be created. They would help with meals, bed making and support for residents. This would enable staff to concentrate on providing care. Ridgeway House DS0000028401.V352914.R01.S.doc Version 5.2 Page 25 Care leaders had been allocated 7 hours each every month for administrative duties. A care leader from another home in the organisation was due to be seconded to act as head of care. Miss Walton said that staff vacancies were being filled. She said that Criminal Records Bureau certificates were awaited for 2 staff. All new staff spend a period of time shadowing a more experienced member of staff during their induction. Other newer staff told us about the training they had received since working for the organisation. This included, working with people with dementia, first aid, fire safety, moving and handling and NVQ Level 2. The recruitment process was robust with all the necessary checks being carried out. No staff commences work until the home checks the Protection of Vulnerable Adults list to ensure that they are suitable to work with vulnerable people. Most of the information and documentation required by regulation was on file. Miss Walton said that she was in the process of obtaining recent photographs of staff. Staff were seen to engage with residents in a friendly and professional manner. It was clear that good relationships had been established. Staff were confident in talking about all aspects of their work with us. A head of care from one of the other homes in the organisation was due to be seconded for a period of three months. This was to support the work in transferring care plans to the new format. Each of the senior staff had a delegated area of responsibility, for example, medication, the rota and tissue viability. Miss Walton was in the process of transferring all the written training records onto the organisation’s computerised record. This new system would enable her to track attendance at core and essential training throughout the year. Course could also be booked on line. Staff had received recent training in dealing with difficult people, working with people with a visual impairment, caring for people who have had a stroke, the Mental Capacity Act 2005, depression and self harm in older people, from the consultant psychiatrist. It is intended that a member of staff in each of the organisation’s home is the ‘dementia champion’. Those staff were undertaking training during that week. All staff receive regular updated training in mandatory subject. These include: health and safety, first aid, dementia care, fire prevention, infection control and moving and handling. NVQs are made available to all staff. Two housekeepers and 3 night staff were undertaking NVQ Level 2. Staff had access to the organisation’s e-learning programme. Staff said they all worked well as a team and were very supportive of each other. Newer staff said they had been made to feel welcome by other staff. Staff said they had regular supervision and regular meetings of the different Ridgeway House DS0000028401.V352914.R01.S.doc Version 5.2 Page 26 staff groups. Staff also said that Mr Titcombe the Operations Manager met with them during the monthly unannounced visits. In a survey form one of the relatives wrote: “[Re keeping in touch] Yes – Ridgeway House staff are excellent on the whole and think of my needs/circumstances as well as [the resident’s].” Another relative wrote: “[re staff experience & skills] the care staff seem very caring, supportive and skilled in their work – always cheerful and helpful.” Another relative wrote: “[re staff] They have patience, tolerance, a great sense of humour and they listen. Another relative wrote: “[can improve] there should be more carers. For the money you pay it always seems there’s not enough staff.” Ridgeway House DS0000028401.V352914.R01.S.doc Version 5.2 Page 27 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Miss Walton has a history of providing good management in her previous manager’s post with the organisation. She is well qualified and keeps herself up to date with current good practice. Miss Walton has a clear idea of how she intends to develop the home. She has actioned all of the requirements from the last inspection. The home is run in the best interests of the residents. systems are in place to ensure any monies held on residents behalf is properly managed. Systems are in place to ensure safety of residents, staff and others. EVIDENCE: The home had had a period of time without a permanent manager. Miss Walton has managed this home for just under a year. During that time she Ridgeway House DS0000028401.V352914.R01.S.doc Version 5.2 Page 28 has put significant effort into improving standards where needed. Miss Walton has successfully managed another home in the organisation. Discussions with Miss Walton showed that she is clear about how she intends to develop the home in line with her own values of putting residents at the heart everything that she does and the organisation’s aims and objectives. All of the residents spoken with knew who she was. One resident spoke of her by her first name and made very positive comments. Miss Walton keeps herself up to date with current good practice through regular training. Action had been taken to address the recommendation we made about residents routinely signing the transaction sheets when withdrawing their personal monies kept in the home’s safe. Residents can keep small amounts of cash in the home’s safe. Records and receipts are kept of all transactions. Residents can access their money at any time. Action had been taken to meet the requirement we made that all staff received regular one to one supervision. We said that this must be recorded and the process monitored by the manager. One of the care leaders told us that senior staff had access to a course in supervisory management. There was evidence on file that regular staff supervision is now well established. The organisation carries out yearly quality reviews on the service. This involves sending out and collating responses to surveys. These are sent to residents, relatives and others involved in the care programmes. Once the responses have been collated, an action plan is produced and monitored during monthly visits by the organisation. Residents meetings are held every three months with minutes kept. Miss Walton monitors the accident records each month. Systems are in place for regularly auditing the health and safety of the environment, use of equipment and any task that staff have to carry out. In a survey form one of the relatives wrote: “The new manager Ellie seems to have improved standards all round.” Another relative wrote: “I think [the resident] I feel very lucky that Ridgeway House is run so well. [the resident] seems very content living there. It has a friendly, open atmosphere I wish the staff were paid more for what must be a very demanding job – physically, mentally emotionally. I am glad you inspect homes and ask for feedback in this way.” Another relative wrote: “Ellie Watson[sic] seems very capable & I trust her.” Ridgeway House DS0000028401.V352914.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X 3 X X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 Ridgeway House DS0000028401.V352914.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP27 Regulation 18(1)(a) Requirement Timescale for action 27/11/07 2 OP7 OP8 17(1)(a) Schedule 3 para 3(m)&(n) The person registered must ensure that residents receive continuity in staffing levels across the week. The person registered must 27/11/07 ensure that the care plans record any healthcare plans, which may be carried out by the district or GP. This must include details of wound care management and progress and diabetes management. 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 OP8 OP19 Good Practice Recommendations Fluid charts should show an indication of quantities of drinks taken. Consider ways to provide for homeliness in bathrooms and toilets. DS0000028401.V352914.R01.S.doc Version 5.2 Page 31 Ridgeway House 3. 4 5 6 OP20 OP37 OP37 OP37 Improve access to the gardens by provision of walkways with even surfaces. Care should be taken to ensure that all current care needs are captured when transferring information to the new care planning documentation. Bathing risk assessments should record whether residents can be left alone to bathe and for how long The outcome of nutritional assessment should inform the pressure damage risk assessments. Ridgeway House DS0000028401.V352914.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection South West Regional Office 4th Floor, Colston 33 33 Colston Avenue Bristol BS1 4UA 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 House DS0000028401.V352914.R01.S.doc Version 5.2 Page 33 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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