CARE HOMES FOR OLDER PEOPLE
Ridgeway Lodge Brandreth Avenue Dunstable Beds LU5 4RE Lead Inspector
Dragan Cvejic Unannounced 30 June 2005 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 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 I51 s14952 Ridgeway Lodge v241664 300605 stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Ridgeway Lodge Address Brandreth Avenue Dunstable Beds LU5 4RE 01582 667832 01582 478485 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) BUPA Care Homes (Bedfordshire) Ltd Cheryle Horne Care Home 60 Category(ies) of OP - Older People (60) registration, with number DE(E) - Dementia over 65 (60) of places PD(E) - Physical Disablility over 65 (60) Ridgeway Lodge I51 s14952 Ridgeway Lodge v241664 300605 stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 17/03/05 Brief Description of the Service: Ridgeway Lodge is a purpose built home with accommodation spread over two floors for up to sixty older people. The home is operated and managed by BUPA. The home had two lifts that connect floors. Divided into units for easier operation, the home managed to maintain a homely atmosphere despite its size. The first floor accommodated service users with considerable confusion and the door to the stairs was coded for security and safety reasons. The manager stated that some, less confused service users knew the code and were coming to the ground floor when they wanted. The home cared for a variety of service users’ conditions, such as confusion as a symptom of dementia, frailty of old age, some physical and mobility problems and sensory impairments. The home offered 4 intermediate care beds for 2-4 weeks stay, (the breather beds). Al bedrooms were en-suite.The garden was enclosed behind the building and there were parking places in the front. Subsequently, after the inspection, the home added another bedroom and variation to registration was approved, increasing the number to 61. Ridgeway Lodge I51 s14952 Ridgeway Lodge v241664 300605 stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out during one working day, from 12.00 to 19.00 hours. The methodology used was case tracking, document reading, consulting the management, 8 service users and 2 staff members. A current Protection Of Vulnerable Adults (POVA) investigation was discussed and the inspector was up-dated with the current stage. The home cared for a variety of service users’ conditions. Frailty due to old age, was the main group of users, these are generally based downstairs, while the first floor had many users with dementia. Some service users had physical disabilities. What the service does well:
The home promoted independence. This was set as one of the home’s objectives and philosophy. The home cooperated very well with Social Services. This cooperation resulted in much more information being collected during the pre-admission assessment. The assessors used this information to decide if they could completely respond to the needs of a prospective service user. The information that the home provided regarding what was offered was included in the statement of purpose and the service user’s guide. Both documents were under review and the Manager stated that it was unlikely that anything significant would change. However, by regularly reviewing these documents the Manager ensured that up to date information was always available. Records kept in the home were generally good and informative to the appropriate people. The atmosphere in the home was good, the staff were helping each other and the Manager specially mentioned some good Polish staff, recently employed. Two of them were awarded the Personal Best Badges for achievement at work. One of the seniors on duty at the end of her shift commented in front of the inspector: “I really enjoyed this shift.” The training was very good. The Manager proudly produced a copy of training records to demonstrate the variety and that all staff were undertaking training regularly. Similar comments were collected from service users. “As far as I am concerned, this is my HOME”, a service user said among other comments on food and respect for her preferences: “I get yoghurt instead of milk, they know
Ridgeway Lodge I51 s14952 Ridgeway Lodge v241664 300605 stage 4.doc Version 1.40 Page 6 I don’t like milk”. Another service user stated: “I am quite independent. I clean my glasses myself. I know my money pays their wages, but they all treat me well.” She continued: “In the last three days they have been taking me up the corridor, there, I use grab rails and I can walk, it is so nice to be able to walk”. Many service users spoken to, stated that they liked being in this home. What has improved since the last inspection? What they could do better:
The Manager stated that she planned to improve further supervisions, both in terms of quality and frequency. There was a planned session for explaining the key worker’s role, as there were some inconsistencies in understanding what the key workers do. The Manager hoped to improve communication between junior staff and seniors. The Manager stated that new staff that were coming to work in care, were all asked to take part in planning, organising and providing activities. This, new principle was expected to improve the activities and make them more suitable for service users conditions. It was hoped that this improvement would attract more service users to join the organised, structured activities. Although the NVQ training attendance was on the raising line, the expected ratio of 50 NVQ qualified staff was not reached. The Manager explained the budget and the plans to change the carpets on the first floor, as they were a bit worn and stained.
Ridgeway Lodge I51 s14952 Ridgeway Lodge v241664 300605 stage 4.doc Version 1.40 Page 7 The home would need to re-arrange recording of some medication, so that monitoring could be more effective and provide the accurate outcomes of the process. 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. Ridgeway Lodge I51 s14952 Ridgeway Lodge v241664 300605 stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Ridgeway Lodge I51 s14952 Ridgeway Lodge v241664 300605 stage 4.doc Version 1.40 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,3,4 The home provided sufficient and appropriate information that allowed service users to make an informed decision about their choice of home. The home assessed all new service users to ensure they could meet their needs upon admission. EVIDENCE: The home provided an information pack that contained a statement of purpose, service user’s guide and the home brochure, where all necessary information was provided. The Manager was just reviewing a statement of purpose and a service user’s guide. The organisation produced a general terms and conditions booklet that was part of the pack. The home improved communication and cooperation with social services and the admission assessment contained appropriate amount and quality of information about service users prior to admission. The home also carried out their own assessment that ensured they could offer a place to the potential service users whose needs would be fully met. The service users’ files contained assessment documents that were regularly reviewed and used as the base for care plans.
Ridgeway Lodge I51 s14952 Ridgeway Lodge v241664 300605 stage 4.doc Version 1.40 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9,10 The documents held for service users in their files were well organised, structured, systematically sorted and contained sufficient information that allowed staff to work in a consistent and effective manner. EVIDENCE: The service users’ files were well organised. Care plans contained sufficient information on identified needs and clearly stated issues, responsibilities and expected outcomes. The files contained a discharge letter, initial assessment, input of medical professionals, property list, care plan and review-evaluation sheet at the back, risk assessment, report sheet and appropriate charts for each individual. The files demonstrated that all aspects of care, relative to the individual, were addressed in the file, either in the care plan or on appropriate charts and records. Administering medication was observed and it was appropriate. Most records related to medication were accurate, but the transfer of amount of medication, when carried over from one to another MAR chart was not recorded.
Ridgeway Lodge I51 s14952 Ridgeway Lodge v241664 300605 stage 4.doc Version 1.40 Page 11 Privacy and dignity were respected. Eight service users spoken to commented that their dignity was respected. A service user stated: “I choose what I want to do.” A comment from a service user who began walking independently again in the home after not being able to, highlighted how the home worked on improving service users conditions in cooperation with physiotherapists and other medical professionals. Ridgeway Lodge I51 s14952 Ridgeway Lodge v241664 300605 stage 4.doc Version 1.40 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14,15 The home met the standards regarding activities, but both the home and the inspector felt that the activities could be seen as the area where the home could work cooperatively with service users to exceed the standards. EVIDENCE: A list of activities was displayed in the home. Service users’ monthly meetings addressed activities and daily routine. The home employed an activity organiser. The home was constantly introducing new measures to improve users’ satisfaction with the activities. One of the new initiatives to improve this aspect of care was to engage all new workers to work cooperatively and to support the activity organiser. This arrangement also helped better communication and was used to improve communication. Activities were organised separately for each floor as the conditions of service users were different and different activities suited their needs. Visitors were welcome in the home and were offered the use of tea-making facilities. There was a current POVA investigation carried out in the home related to the visitor. Learning from the incident that led to this investigation, the home was considering how to further improve the safety of all service users. The options considered might affect the freedom of movement through the home for visitors, or could lead to the termination of the contract for a
Ridgeway Lodge I51 s14952 Ridgeway Lodge v241664 300605 stage 4.doc Version 1.40 Page 13 service user. The Manager was asking for external advice and was considering all options. Autonomy and choice were promoted and encouraged. Service users meetings were organised monthly and were well attended. Service users were deciding on food, activities, visiting arrangements etc. The minutes of meetings were displayed. Mealtimes were relaxed and comfortable. The service users decided that the meat was not of high quality and requested action from the Management structure. This resulted in the change of the meat supplier and the results were very positive and the quality had improved. Ridgeway Lodge I51 s14952 Ridgeway Lodge v241664 300605 stage 4.doc Version 1.40 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,18 The home effectively dealt with protection of service users and their clear policy and procedure helped them achieve this goal. EVIDENCE: The home displayed their complaint procedure and made it available to all those who potentially may make a complaint. The investigation procedure included appointing an independent investigator to conduct investigation impartially. The home worked successfully on protection of service users. A recent POVA investigation was used to identify the most effective way for protection of service users. The Manager presented documentation related to POVA investigation that demonstrated appropriateness of the process, up to the stage achieved by the time of this inspection. Ridgeway Lodge I51 s14952 Ridgeway Lodge v241664 300605 stage 4.doc Version 1.40 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,22,24 The home was suitable for service users needs. The size of the home that would indicate potential institutionalisation was overcome by the effective organisational solution. EVIDENCE: The building was suitable for the category of service users and their conditions. It was well maintained and a regular renewal programme ensured the state of repair was appropriate. The carpet on the second floor showed signs of wear and tear and was due for replacement. Individual accommodation was personalised with privately owned items and provided a homely feelings despite the size of the home. A new bedroom was created by re-organising internal setting: The Manager’s office was moved downstairs, making it more accessible; the hairdressing salon was also moved and this room had been converted to another bedroom. Ridgeway Lodge I51 s14952 Ridgeway Lodge v241664 300605 stage 4.doc Version 1.40 Page 16 Individual bedrooms seen during this inspection met the standards. Service users showed to the inspector their personal memorable items in their rooms that made them individualised and homely. Ridgeway Lodge I51 s14952 Ridgeway Lodge v241664 300605 stage 4.doc Version 1.40 Page 17 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,30 The home employed sufficient number of skilled and committed staff that were able to respond to the needs of service users and ensure the good level of care was offered to each individual. EVIDENCE: The Manager planned and deployed staff on a rota, that ensured that enough and appropriate staff worked on each shift. The basic guide for determining the number of staff per shift, were service users’ needs. There were two extra staff members funded by social services, as the home justified the need to employ them in order to meet the needs of a particular service user. Although the home offered good basic training, the low percentage of NVQ qualified staff had just been addressed and resulted in 9 staff working towards the qualification. All new staff have been inducted on TOPSS principles. Staff commented that the training offered to them was appropriate and sufficient. Training records demonstrated that mandatory training was up to date and that training was organised in a planned way. Ridgeway Lodge I51 s14952 Ridgeway Lodge v241664 300605 stage 4.doc Version 1.40 Page 18 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,36,37,38 The home was well managed by the experienced Manager who created the open and constructive atmosphere that had a significant, positive impact on service users satisfaction, safety, comfort and well being. EVIDENCE: The Manager had the skills, experience and knowledge necessary for managing this home. The open and inclusive atmosphere in the home was acknowledged and praised by service users and staff, in questionnaires used for quality assurance reviews. Staff worked in a supportive manner in a well organised way. Staff suggestions for improvement resulted in permanently locating a senior staff member on the first floor, this improved the care process. Minimal use of the agency staff also contributed to the consistent approach when delivering care. The budget showed that the home overspent on staffing due to employing staff over the budgeted figure, but compensated this by targeting some other categories, such as maintenance, that did not need additional investment.
Ridgeway Lodge I51 s14952 Ridgeway Lodge v241664 300605 stage 4.doc Version 1.40 Page 19 The staff were regularly trained in all mandatory training topics and attended training related to service users’ conditions, such as dementia and Alzheimer’s disease. Although supervision records demonstrated less than two monthly supervisions for some staff, the Manager showed plans that would ensure that all staff were supervised 6 times a year. After training senior staff in health and safety, with particular attention to recording accidents/incidents, this aspect of care was significantly improved. The home was regularly inspected by other relevant authorities, such as fire, health and safety, environmental health and various maintenance related authorities that inspected gas and electrics, water etc. The home kept records of water temperatures. The Manager arranged for the new room to have its water temperatures checked on a daily basis for the first two weeks, before adding it to the regular weekly checks. Ridgeway Lodge I51 s14952 Ridgeway Lodge v241664 300605 stage 4.doc Version 1.40 Page 20 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 3 x x 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 3 15 3
COMPLAINTS AND PROTECTION 3 3 x 3 x 3 x x STAFFING Standard No Score 27 3 28 2 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 4 3 3 x x 3 3 Ridgeway Lodge I51 s14952 Ridgeway Lodge v241664 300605 stage 4.doc Version 1.40 Page 21 no Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 9 Regulation 13 Requirement The transfer of medication from one to another MAR sheet must record amount of transferred medication to allow for monitoring and auditing process to be carried out accurately. Timescale for action 30/08/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard 19 28 Good Practice Recommendations The carpets on the first floor should be replaced. The home should continue to promote the NVQ training in order to achieve 50 of NVQ trained staff. Ridgeway Lodge I51 s14952 Ridgeway Lodge v241664 300605 stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection Clifton House 4a Goldington Road Bedford MK40 3NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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