Inspection on 14/05/07 for Ridgeway Lodge

This inspection was carried out on 14th May 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 Lodge 10/10/06

Ridgeway Lodge 06/10/05

Ridgeway Lodge 30/06/05

Ridgeway Lodge 17/03/05

Ridgeway Lodge 14/09/04

Ridgeway Lodge 24/03/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bramley Avenue (73)

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Ridgeway Lodge Brandreth Avenue Dunstable Bedfordshire LU5 4RE Lead Inspector Leonorah Milton Unannounced Inspection 14th May 2007 10:00 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 Lodge DS0000014952.V334815.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 Lodge DS0000014952.V334815.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ridgeway Lodge Address Brandreth Avenue Dunstable Bedfordshire LU5 4RE 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) 01582 667832 01582 478485 BUPA Care Homes (Bedfordshire) Ltd ** Post Vacant *** Care Home 61 Category(ies) of Dementia - over 65 years of age (61), Old age, registration, with number not falling within any other category (61), of places Physical disability over 65 years of age (61) Ridgeway Lodge DS0000014952.V334815.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 10th October 2006 Brief Description of the Service: Ridgeway Lodge is a purpose built care home registered to provide for sixtyone frail adults over the age of sixty-five who may also have dementia and/or physical disabilities. The home was operated by BUPA Care Homes (Bedfordshire) Ltd. The manager had been in post since July 2006 but delay to submit a complete application to the Commission for Social Care Inspection meant that she had yet to be registered in that position. The building had been finished to a high specification that met the National Minimum Standards and provided single room accommodation on the two levels of the home. The layout of the building had been designed to promote the ethos of small group living, each of the units having a lounge and dining area with toilets and bathrooms in close proximity. The building had an inner quadrangle type garden that was well stocked with flowers and shrubbery and provided a pleasant out look and congenial place for relaxation. The home was located in a residential suburb within walking distance of local shops. The towns of Dunstable, Houghton Regis and Luton were short car journeys away. Fees for accommodation were between £407 and £642 weekly. Ridgeway Lodge DS0000014952.V334815.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report sets out the significant evidence that has been collated by the Commission for Social Care Inspection since the last visit to and public report on, the home’s service provision in October 2006. Reports from the home, other statutory agencies, and information gathered at the site visit to the home, which was carried out on 14th May 2006 between 10.00 and 19.10 were taken into account. The Commission had received information since the last inspection about medication errors. As a result two visits to the home were carried out to assess action taken to improve medication procedures. These visits identified that people living in the home had not received their prescribed medication. The Commission subsequently issued a notification that required urgent action be taken to improve this situation. At this visit key standards for the operation of a care home were assessed with particular emphasis on the home’s medication procedures. The Commission’s pharmacist inspector attended to review these procedures. His assessment has been incorporated into this report. Other aspects of the visit included a review of the case files for three people living in the home, conversations with seven people, two visitors, a district nurse, four members of staff, the manager and also the operations manager and quality assurance manager. Much of the time was spent in the communal areas of the building with people living in the home, where the daily lifestyle was observed. A partial tour of the building was carried out and other records were reviewed. The Commission had received eighteen responses, completed by people living in the home or their representative, to a questionnaire circulated prior to this inspection. These have been taken into account and reflected in this report. What the service does well: This purpose built home provided spacious and comfortable accommodation. The layout of the building provided a variety of places in which to relax quietly or socialise in the company of others. Despite the size of the home, the arrangement of small living areas had enabled the service to create a homely environment and atmosphere. These arrangements had enabled the home to care for people with diverse needs. The building was well decorated and comfortably furnished. Arrangements to maintain a safe place to live and work in were good. Ridgeway Lodge DS0000014952.V334815.R01.S.doc Version 5.2 Page 6 People living in the home who contributed to the inspection were mostly positive about their experiences in the home. Members of staff who worked permanently in the home were described as “Nice”, “Marvellous”, “Alright”. One person said “I am lucky to live here” and another, “I inspected everywhere this is without doubt the best”. It was evident that visitors were welcomed into the home. Two visitors reported that they had been able to raise their concerns about their relatives’ care and action had been taken accordingly. What has improved since the last inspection? What they could do better: Comments passed by people living in the home indicated that one of their main concerns was the large number of agency personnel working in the home and the impact this had on the continuity of care. The home however had undertaken an extensive recruitment drive and it was anticipated that this situation should be resolved in the near future. Despite the extensive retraining programme in safe medication procedures there were still outstanding issues. Action must be taken to ensure that medicines are administered within safe timescales between dosages; records detail exact dosages given; there must be clear guidelines to indicate when variable doses of medicine or those prescribed on and “as required” basis are to be given; the ability of people living in the home to safely hold and administer their medication and any risks to other people living in the home must be assessed; medicines must be stored at appropriate temperatures and under secure conditions that meet legal requirements. People living in the home must receive the level of support they require including the arrangement of transport for hospital appointments. Ridgeway Lodge DS0000014952.V334815.R01.S.doc Version 5.2 Page 7 People living in the home should be supported to bathe on a regular basis. Where there are barriers to this, assessments of need and corresponding care plans should show why people are unable or reluctant to bathe. People living in the home must be able to move around the home and go out without restriction. This means they must be given the numbers of the key pads for the doors to enter the building and on the staircases, unless a risk assessment has established this would not be in their best interests. Meals served should be in accordance with advertised menus. Care plans should include more detail about food preferences. Staff should receive supervision at least six times each year. Staff management systems should be transparent. Minutes of meetings should be sufficiently detailed to provide information to those who were unable to attend meetings. The statement of purpose must provide an accurate guide to the service provision. The turnover of staff and the changes to the operation of the home had resulted in low morale amongst some members of the team. Action should be taken to consolidate the team, in particular the senior team, so that people living in the home are reassured that the home is operated by a cohesive and competent workforce. 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 Lodge DS0000014952.V334815.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 Lodge DS0000014952.V334815.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): Standards 1,3,6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Pre-admission assessment procedures had ensured that the home had the capability to care for people admitted to the home. EVIDENCE: Three case files were assessed. The file for the most recent admission showed an improvement on the previous pre-admission assessment procedures. This file contained an assessment that covered the areas of need detailed by the National Minimum Standard. A copy of the Statement of Purpose was given to the inspector. It provided an easy read guide to the service. The details however were not entirely accurate and did not conform to Schedule 1 of the Care Homes Regulations: a central administrative office was listed as the registered address, which was not the case. The manager was detailed as registered in her post. This was also not the case. Ridgeway Lodge DS0000014952.V334815.R01.S.doc Version 5.2 Page 10 The sections for the age range and sex of service users and range of needs the home can accommodate were muddled up. Section 15 referred to a keyworker being the resident’s advocate. The Commission’s view on the role of an advocate is that it is someone who is independent of the organisation, who acts on behalf of the resident. Sections that made reference to the organisation’s corporate procedures would not be helpful to any prospective customer unless they also had access to these procedures. The home provided respite care but not an intermediate care service. Ridgeway Lodge DS0000014952.V334815.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): Standards 7,8,9,10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The handling and recording of some medication did not meet the required standard and could put at risk the health and well being of the people using the service. There were some instances when people felt that they had not received the level of support they required. EVIDENCE: Three case files were assessed. The care plans seen were based on thorough assessments of need. Plans covered people’s personal, physical, health, recreational, social and emotional needs. Documents listing peoples’ preferences for their daily lifestyle had been completed. These listed preferred times for getting up and going to bed, preferred beverages, frequency for bathing, hairdressing and similar. It was disappointing that preferences for food were not recorded. Given that some people were unable to articulate their needs and given the use of agency personnel it was difficult to assess how peoples’ preferences for meals were known by all those serving food. Ridgeway Lodge DS0000014952.V334815.R01.S.doc Version 5.2 Page 12 Records seen and conversations with people showed the home had taken appropriate steps in most instances to meet their health care needs. Records indicated that appointments had been made for routine treatments such as chiropody and optical care and to their doctors as the need had arisen. However, feed back from one person, as detailed below, showed that they had not been supported to attend appointments. The previous report had commented on the failings to carry out assessments in relation to falls. Action had been taken on this. Records indicated that referrals had been made to doctors. A person living in the home spoke to the inspector about their concerns that they had not received sufficient assistance to put on support hose in the mornings. They also said that they didn’t think all those who assisted them were aware of the correct way to fit the hose. The inspector subsequently raised this issue with the manager who indicated that the resident had already spoken to her about this concern. This evidently had not resulted in action that suited the resident. One of the questionnaires commented, “Sometimes care staff do not take the time to cater for her needs”. The document did not specify particular needs that were unmet. A written comment stated, “Lack of attention when requesting a GP to attend”. Another wrote, “I need hospital transport to call for me for hospital appointments on several occasions this is not followed up so I have missed some appointments because transport needs have been neglected. This is not a medical short coming but a staff one”. Other responses indicated people were mostly satisfied with the level of support they had received. The survey indicated that four of the eighteen people who responded “always” received the level of care and support they needed, nine people responded “usually”, and four people responded “sometimes”. Nine people indicated “always” to the level of support for medical care, seven people responded, “usually” and two “sometimes”. People who contributed to the inspection indicated that they were on the whole satisfied with the way they were treated by staff. “ Staff are alright, some you get on with better then others, but mustn’t grumble”, “ Staff are very kind”, “Mostly the staff are kind”, “Staff have been very nice to me. I am well treated”. Clear and detailed medicine handling procedures were available to the care staff but they do not always follow these procedures, which are there to protect residents. Ridgeway Lodge DS0000014952.V334815.R01.S.doc Version 5.2 Page 13 Clear records were kept of medications coming into and leaving the home. Records were kept when medication was given to service users. However there were some problems with these records. • • • • When medicines are not given at the time printed on the medication chart, the actual time it is given is not recorded and so residents are at risk of being given doses of medicines too close together. Some unexplained omissions in the records of medicines given to residents so there is no clear indication if medicines had been given or not. When medication is prescribed in variable doses or on a “when required” basis, there are no clear guidelines for staff on what dose to give or when. When medication charts are hand-written by care staff the date that medication is given to residents is sometimes unclear. Most people had their medication given to them by designated trained care staff. Members of staff only administer medicines following a training program and a competence assessment. Some people did hold and administer some of their own medications. Their ability to safely hold and administer their medication and any risks to other people living in the home had not been assessed. This could be putting people in this home at an unnecessary risk and is against to the homes medication handling procedures. One carer was watched giving medicines to some people during the site visit. She was seen to given medication to people with respect and to handle the medication safely. Controlled Drugs were being stored in locked cupboards that would meet the Misuse of Drugs (Safe Custody) Regulations 1973 if they were all correctly secured to a solid wall. The usage of Controlled Drugs was being recorded in the Controlled Drugs register and all entries in the register were satisfactory. Medication was stored securely for the protection of the service users. Medication cupboards and trolleys were clean and orderly with the keys being held by the care staff. Daily temperature records were kept but no action had been taken when the readings were outside of the required range. A pathological specimen was found stored alongside medicines in one of the refrigerators and some medication was out of date. Ridgeway Lodge DS0000014952.V334815.R01.S.doc Version 5.2 Page 14 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): Standards 12,13,14 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The majority of people living in the home had been supported to achieve a lifestyle that mostly met their expectations. Peoples’ choices however had been compromised by restrictions to enter and move around the building. EVIDENCE: Discussions with people on the day of the visits and the results of the survey indicated that the majority were satisfied with the arrangements for activities for recreation and stimulation. Those spoken to confirmed that daily routines were quite relaxed, “I can do mostly what I want”, and “There are no rules”. One person explained that they had been lonely in their own home and was happy to live at Ridgeway Lodge because of the company and activities. Access to the home and to the upper floor was restricted by keypad entry systems. The upper floor could be accessed by the lift, which was not restricted. Two visitors to the home confirmed that they had been given these codes. Whilst visitors were free to come and go at will this did not apply to people living in the home. The operations manager explained that it had not Ridgeway Lodge DS0000014952.V334815.R01.S.doc Version 5.2 Page 15 been the home’s policy to give these numbers to people living in the home. If they wished to go out they could ask for the door to be opened. It was also explained that no one had ever asked for these numbers. It was concerning that there were no assessments in place to qualify that the withholding of these access codes from people living in the home was in their best interests. There was no evidence to show that people, who had the capacity to make a decision in this matter, had been consulted about their wishes. People had been able to bring items of a personal nature into the home and to handle their personal finances where they had the capacity to do so. Care plans seen contained nutritional assessments of need. Documents in the dining areas showed that dietary needs such as diabetes, soft diet, and liquidised meals had been noted. There was however little reference to individual likes and dislikes in care plans or dining areas. Menus showed a nutritious and varied choice. However the meal served on the day of the visit did not adhere entirely to the advertised menu. Staff confirmed that it was often the case. The manager explained the arrangements for mealtimes had been reviewed and changed from five to four areas and that additional staffing had been arranged. It was felt people living in the home had benefited from this re-organisation. People living in the home were mostly satisfied with their meals and beverages. The survey showed that five of eighteen people, “always” liked the meals, eight “usually” and five, “ sometimes”. Comments, verbal and written, included, “A great improvement in meals”, Too bland to eat”, “The food is good and there is plenty of it”, “Meals are nice, “Fluids to be hot and not lukewarm”, “We have an early restaurant assistant who makes a very good job of serving breakfast but the rest of the day’s meals are in anybody’s hands. Some do it well some do not and when they do not they spoil any meal”. Ridgeway Lodge DS0000014952.V334815.R01.S.doc Version 5.2 Page 16 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): Standards 16,18 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The implementation of safe medication procedures following investigations carried out under the home’s protection procedures had not entirely removed the risks to peoples’ health and well being. EVIDENCE: Previous inspections had identified the home had robust written complaints and protection procedures. Responses to the questionnaire showed that sixteen people knew how to make a complaint, two did not. People commented, “I would talk to staff”. “ I think they would listen to me here.” Records seen showed that there had been no significant complaints since the last inspection. Records however had been maintained about concerns of minor day-to-day issues and how these had been resolved. Since the last inspection the home had had appropriately reported under procedures for the Protection of Vulnerable Adults, incidents of concern in relation to medication errors and assisted in the investigation of these issues. The home had arranged for retaining of staff and a change of provider for prescribed medication. Subsequent visits had shown the home had still failed to ensure that peoples’ well being was protected through its practices for the Ridgeway Lodge DS0000014952.V334815.R01.S.doc Version 5.2 Page 17 administration and recording of medications. This had resulted in enforcement proceedings. This inspection, as detailed in section 3, showed that although medication procedures were still not entirely satisfactory, there had been significant improvement. Conversations with members of staff showed they had been briefed and were aware of procedures to protect people living in the home from abuse. Records indicated that training for personnel in protection procedures was taking place. Records indicated only a few personnel had not received such training. Records indicated recruitment procedures had been sufficient to ensure the background of candidates for employment had been checked to ensure that members of staff working in the home were of the right calibre to work with vulnerable people. Ridgeway Lodge DS0000014952.V334815.R01.S.doc Version 5.2 Page 18 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): Standards 19,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The building had been purpose built and provided a comfortable, well-adapted environment that was suitable to peoples’ needs. EVIDENCE: Procedures were in place to ensure that the safety of the building and its equipment through regular maintenance checks and servicing by qualified contractors. Procedures were in place to control the risk of infection during laundry processes. The assistant working in the laundry at the time of the inspection visit was knowledgeable about infection control measures. Ridgeway Lodge DS0000014952.V334815.R01.S.doc Version 5.2 Page 19 The building on the whole was well decorated and furnished. Peoples’ bedrooms, whilst quite uniform in layout, décor and furnishings, had been individualised by personal possessions. Many rooms had achieved a homely appearance. Action had been taken to remove the unpleasant odour on the upper floor. All of those who responded to the questionnaire indicated that the home was “always” fresh and clean. Ridgeway Lodge DS0000014952.V334815.R01.S.doc Version 5.2 Page 20 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): Standards 27,28,29,30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A turnover in staff since the last inspection meant that the use of agency personnel had not ensured the continuity of care to people living in the home. EVIDENCE: Observation of staff as they worked with the people living in the home showed that they treated people with kindness and respect. It was noted that their dialogue with people with cognitive impairment was sensitive to such needs. Members of staff who were spoken to showed a commitment to the welfare of people living in the home whilst also acknowledging that the home had been through a difficult period. A district nurse remarked on the good standard of care in the home that five people she visited had received. They described staff as “competent” and said there was “a good atmosphere in the home”. Rotas seen and conversations with people living in the home, members of staff and the manager and operations manager indicated there had been a turnover of staff, and a reliance on the use of agency personnel to cover vacant shifts. A member of the senior team had left and two others had accepted posts of less responsibility. Some people living in the home were not satisfied with the staffing situation, particularly at night, “Night staff could be improved”. “ Staff Ridgeway Lodge DS0000014952.V334815.R01.S.doc Version 5.2 Page 21 are ok but night staff keep changing and I don’t know then so much”. A recent rota showed that of the four scheduled night staff, three were agency personnel. A visitor commented, “Staff are nice” but expressed concerns about recent staff changes and the use of agency personnel saying “it is unsettling for residents”. The quality assurance manager and the operations manager explained that there had been an extensive recruitment drive and that several new personnel were scheduled for employment once the necessary background checks had been obtained. Other comments about staffing arrangements confirmed that people were happy with the treatment from individual members of staff, “ Marvellous”, “Very hard working”, “Kind” but also, “Staff are nice but very busy…they tell me how busy they are and I am anxious to ask for help. I feel award”, “ I have been waiting too long”; and “It depends whose on”. Changes to staffing arrangements had meant that the ratio of staff who had achieved National Vocational Qualifications in care had diminished. Less than fifty percent of care staff held these qualifications. Training records indicated that staff had received a basic level of training to carry out their roles, which had covered in most instances manual handing, health and safety, infection control, fire safety and food hygiene. Since the last inspection the provision of training in dementia care had improved and training in protection procedures had been provided for most staff. A recent employee described their induction process and said they felt supported to carry out their job since their appointment. Records seen did not show whether staff had received training in other topics that are relevant to the care of frail older people such as nutritional needs, management of diabetes, continence, skin care and similar. Personnel records were assessed for three care staff, two of whom had worked in the home for more than two years and one since September 2006. The records indicated that two had received training in protection procedures but none of the three had been trained in dementia care. None had received training in basic topics indicated above such as the management of continence and skin care. The records indicated that robust employment procedures had been followed in relation to their appointments. Ridgeway Lodge DS0000014952.V334815.R01.S.doc Version 5.2 Page 22 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): Standards 31,32,33,35,36,38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. It was evident that there had been significant input into the operation of the home from senior managers from the wider organisation. There was however a need to establish a competent senior team within the home so that people living in home could be assured of continuity of care from staff and managers seen on a daily basis. EVIDENCE: The manager had previously been a registered care home manager in a home also operated by BUPA. Reports of that service under her management had been good. She had been appointed to manage Ridgeway Lodge in June 2006. The report of the service in October 2006 noted that she had yet to submit an application to be registered in her current position and required that this be done. This inspection identified that whilst an application had been Ridgeway Lodge DS0000014952.V334815.R01.S.doc Version 5.2 Page 23 submitted it had been returned as incomplete. This significant delay to submit a complete application is entirely unsatisfactory. It was evident that the organisation had decided that the extent of the management issues in the home, which came to light after the last inspection, required additional support for the manager. Visits to the home and discussions with managers showed there had been subsequent input from the operations manager, two quality assurance managers and other senior managers from within the organisation. This had resulted in strategies to improve the performance of the team but had inevitably had an impact on staff morale. This was described by some members of the team as low. Some long serving members of staff, whilst accepting the need for change, described the experiences of being assessed by quality assurance managers from elsewhere in the organisation as “threatening”. It was also said that there were “mixed messages” to staff because it was not clear who was managing the home. One stated the operations manager “runs the home, not the manager”. Another said, “The operations manager is in charge”. Systems for the management of the home were not transparent. Records of staff meetings on at least three instances consisted of a series of bullet points more suited to an agenda and recorded attendance of “staff on duty” rather than identifying individuals attending. It was difficult to see how issues discussed and decisions made would be cascaded to staff not in attendance and how issues would be followed up, there being no reference to minutes of previous meetings or actions arising as is expected of management strategies in home of this size. Other information about the service was also not readily available to staff. A member of staff had contacted the Commission in relation to the report of the previous inspection, saying that they had asked the manager if they could see the report and it had not been forthcoming. At this inspection another member of staff had volunteered the information that they had not been able to see the report within the home and had gained access to it via the Commission’s website. It is accepted that the provision of supervision can become problematic when there are changes in a team, particularly the senior team. This had been identified as a problem at the previous inspection and highlighted again at this inspection. A member of staff stated that they had not had supervision since the new manager had been in post. The operations manager disputed this and explained that all personnel had received at least one supervision during the last year and felt that some members of the team did not realize that meetings with them came under the heading of supervision. It was not clear whether supervision therefore had been carried out along good practice guidelines, which involves a supervision contract and signed records of meetings by both parties. Ridgeway Lodge DS0000014952.V334815.R01.S.doc Version 5.2 Page 24 There was evidence of consultation with people living in the home. The inspector was shown minutes of a meeting with people living in the home on 24th April 2007. The minutes referred to concerns raised in relation to an uncomfortable bed, misleading menus, too many agency personnel, especially at night, availability of staff to assist with bathing, and supplies of cutlery and crockery. There was no indication in these minutes how these issues would be resolved. There had also been a cheese and wine party during which the changes to dining areas had been discussed. An annual review of the service had taken place in December 2006. The report of this review did contain an action plan for issues raised. Health and safety arrangements had been well managed. Information provided showed routine servicing and maintenance of equipment had been carried out by qualified contractors. Members of staff had received training in safe working practices and were seen to use safe practice when moving and handling people, handling food and during the laundering of soiled linen. Access to areas of the building in which there were risks to the safety of those living in the home such as the main kitchen, laundry, lift room and storage areas were restricted. Ridgeway Lodge DS0000014952.V334815.R01.S.doc Version 5.2 Page 25 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 2 x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 3 x x x x x x 3 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 3 x x 1 x 3 Ridgeway Lodge DS0000014952.V334815.R01.S.doc Version 5.2 Page 26 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 OP8 Regulation 13(1) Requirement Timescale for action 14/06/07 1. OP9 12(1) 13(2) 17(1) The registered person must ensure that people living in the home are supported to attend pre-arranged health care appointments. The registered person must 14/06/07 ensure that complete and accurate records are kept of all medication administered or not together a reason why the medicine was not given, the time and date medication is given must be recorded accurately in order to demonstrate that service users receive the medicines prescribed for them. The registered person must provide clear guidance for care staff to show when medication is to be given in variable doses or on a “when required basis” to make sure that people receive the treatment prescribed for them. The registered person must ensure that medicines including controlled drugs are stored in line with the home’s own policy and the Misuse of Drugs Act and DS0000014952.V334815.R01.S.doc 2. OP9 13(2) 13(4)(b) 30/06/07 Ridgeway Lodge Version 5.2 Page 27 associated Regulations to make sure there is suitable security to protect residents. The registered person must ensure that that a documented risk assessment is in place for all service users who administer their own medication in order to minimise the risks to people in this service. Training/briefing must be provided for staff in procedures for the protection of service users. (Previous timescale of 31/01/07 had not been met in full) The home must introduce and implement a staff development plan that has been based on an analysis of individual need. Included in the plan must be: Updates for manual handling Infection control Dementia/diseases/conditions associated with old age Care planning National Vocational Qualification in care Continence management Nutrition for older people. Skin care. (Previous timescale of 31/12/06 had not been met in full) 3. OP18 12(1)(a) 13(6) 31/08/07 4. OP30 12(1)(a) 18(1)(c) 30/11/07 Ridgeway Lodge DS0000014952.V334815.R01.S.doc Version 5.2 Page 28 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. 3. 5. 6. Refer to Standard OP1 OP7 OP7 OP15 OP28 Good Practice Recommendations The statement of purpose should provide an accurate guide to the service that conforms to legal requirements. The home should ensure that people living in the home who have raised concerns about unmet care needs receive an appropriate level of support. Care plans should record more detail about people’s likes and dislikes for food. The home should carry out a detailed consultation with people living in the home to assess their wishes in relation to the content and serving of meals and beverages. The home’s training plan should show how staff will be supported to achieve National Vocational Qualifications in care so that 50 of the home’s care staff hold this qualification. Carried forward from the inspection of October 2006 Staff should receive supervision at least six times per year. Carried forward from the inspection of October 2006 7. OP36 Ridgeway Lodge DS0000014952.V334815.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Bedfordshire & Luton Area Office Clifton House 4a Goldington Road Bedford MK40 3NF 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 Lodge DS0000014952.V334815.R01.S.doc Version 5.2 Page 30 - 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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