CARE HOMES FOR OLDER PEOPLE
Ridgeway Lodge Brandreth Avenue Dunstable Bedfordshire LU5 4RE Lead Inspector
Dragan Cvejic Unannounced Inspection 6th October 2005 09:00 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.V257302.R01.S.doc Version 5.0 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.V257302.R01.S.doc Version 5.0 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 Cheryle Horne 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.V257302.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 30/06/05 Brief Description of the Service: Ridgeway Lodge is a purpose built home with accommodation spread over two floors for up to sixty one older person. 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). All bedrooms were en-suite.The garden was enclosed behind the building and there were parking places in the front. Ridgeway Lodge DS0000014952.V257302.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection that lasted 4 hours. Partial case tracking was the main methodology. The inspector concentrated on outcomes for service users. For this purpose 6 service users were spoken to, three on the ground floor and three on the first floor, designated for service users with dementia. Service users’ bedrooms were checked as well as the area where these 6 users spent their day time. Two visiting district nurses provided comments too. Four staff files were checked and three staff provided their comments to the inspector. The records of service users’ money were checked for 3 service users. What the service does well: What has improved since the last inspection?
Whit extra staff, the home arranged for service users with dementia to use garden and come down much often. A user from the second floor clearly remembered attending a garden party, despite her confusion and forgetfulness.
Ridgeway Lodge DS0000014952.V257302.R01.S.doc Version 5.0 Page 6 Staff started discussing care plans’ goals with service users who were confused and suffered from dementia. This new practice showed the home’s intention to include service users in decision making as much as possible. The medication supplier was changed and the new supplier was more efficient and helpful. A senior staff member in charge of medication was looking into details of the process and introduced some new measures to minimise the risk. 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. Ridgeway Lodge DS0000014952.V257302.R01.S.doc Version 5.0 Page 7 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.V257302.R01.S.doc Version 5.0 Page 8 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 the following standard(s): 3,4,5 The home assessed all new service users to ensure they could meet their needs upon admission. EVIDENCE: Two new service users confirmed that they were thoroughly assessed prior to the admission to the home. They both continued to say that “staff were good and responded to the calls without delay”. The assessment included among other elements, mobility, personal care needs, recent history of needs, mental state, social needs and took into account the level of independence that service users had before the admission. Referring agents were reassured, the same as prospective service users that their needs would be met. The initial assessment was a base for care plan that clearly stated goals and objectives, as checked in the respite care service user’s plan. Service users confirmed that the home used a trial period to continue with the assessment and to offer them the chance to learn how their needs would be met.
Ridgeway Lodge DS0000014952.V257302.R01.S.doc Version 5.0 Page 9 Ridgeway Lodge DS0000014952.V257302.R01.S.doc Version 5.0 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 the following standard(s): 8,9,10 Service users’ health care needs were met with the respect for the level of their independence and wishes and preferences. Medication process was much improved with still some details that could be better. Service users’ privacy was highly respected. EVIDENCE: On the initial assessment the home established the needs of service users and arranged for a replacement wheelchair to be delivered at the time of admission to maintain service user’s independence from the first day in the home. Nine service users were walking in the corridor, lounge and kitchenette on the first floor and the staff were observed cruising through these areas to ensure service users immediate needs are attended and responded to. A service user was helped to move with the special sling, specially ordered for him. Another user was led by two staff to the toilet to prevent potential fall. In one of the lounges a staff member was reviewing a care plan with a service user. When medication was given, a staff member asked and offered medication prescribed on “when needed” basis to a service user.
Ridgeway Lodge DS0000014952.V257302.R01.S.doc Version 5.0 Page 11 Visiting district nurses stated that the home’s records and communication with them ensured that users’ health care needs were met. Medication process had improved and the responsible person looked into details of the process. It was identified that a risk assessment was needed when service users wanted to take medication without being observed. The staff member explained that the new chemist was consulted in order to change medication delivered in boxes to the blister pack that would reduce the hazard of mistakes. The solution was sought for precisely measuring liquidised medication. Even the sample signatures of staff administering medication were considered to be addressed in case of staff changing surnames due to marriage, and to keep these samples up to date. The staff always knocked on the users’ doors before entering their rooms. All users were appropriately dressed. Four users commented that they were helped the way they wanted to. A respite user stated that he very much appreciated being respected regarding his independence level. Another user added that the electrical wheelchair he used “allowed him to be 99 independent.” The level of respect for users’ privacy exceeded the standards. Ridgeway Lodge DS0000014952.V257302.R01.S.doc Version 5.0 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 the following standard(s): 14 The pace of life in the home allowed service users to lead the life that suited their abilities and conditions. The choice and respect for their individual wishes were not only promoted, but represented the main philosophy of the home. EVIDENCE: A service user stated that the activities were better since the home employed a new activity co-ordinator. He continued saying that he was regularly called to join activities, but that his decisions to join or not were fully respected. He commented that on user’s meetings they could suggest and staff would ensure that proposed activity was organised. Two service users from the first floor talked in length of the garden party, recently organised in the home. One of them continued and commented that she liked drawing and painting and made a few pictures. A service user explained how his choice was respected. “I control my money; the staff buy me cigarettes and I never run out. I can control the temperature in my room, I can just about reach the control knob. I decide when to get up and go to bed. I brought in my electric wheelchair that allow me to maintain my independence.” Service users were using all parts of the home, but the connection of the first and ground floor was controlled by staff. This procedure ensured safety and all service users spoken to and confirmed that they were happy with the
Ridgeway Lodge DS0000014952.V257302.R01.S.doc Version 5.0 Page 13 arrangement by which the users with dementia and those with general old age conditions mixed under staff control, but had their areas where they could move without restrictions. A service user commented: “We are very respected here, we get tea or coffee whenever we want. Plus, if you want to you can go to the kitchenette and make yourself tea or coffee.” The respect shown to service users exceeded the standards. Ridgeway Lodge DS0000014952.V257302.R01.S.doc Version 5.0 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 the following standard(s): 16 The home had a satisfactory complaints system and service users felt that their views were listened to and acted upon. EVIDENCE: The complaints procedure was displayed in the main hall. It was also included in service user’s guide. It contained a set time scale for investigation. The company, BUPA, had a policy by which all more serious complaints were investigated by an independent investigator. The home did not receive any complaint since the last inspection. Ridgeway Lodge DS0000014952.V257302.R01.S.doc Version 5.0 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 the following standard(s): 22,24 Service users enjoyed their well maintained and appropriately furnished and adapted rooms. Communal areas were also pleasant, clean, airy and offered a comfortable place where service users spent most of their comfortable day time. EVIDENCE: The bedrooms of case tracked service users were checked and met the standards. Service users confirmed that their rooms and the home in general met their environmental needs. Ridgeway Lodge DS0000014952.V257302.R01.S.doc Version 5.0 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 The home employed skilled and motivated staff who ensured that service users’ needs were met. EVIDENCE: The home had two staff members whose posts were funded by social services and who were employed to ensure that increasing needs of service users were met in the home without the need to move them to a home for higher dependency level. Service users spoken to confirmed that staff were appropriately and timely responding to their needs. Due to emphasis on other training and BUPA’s Personal Best programme, and while the management was identifying new sources for funding, the level of the NVQ trained staff was fluctuating around 50 , but there were periods were the percentage was lower that minimum required of 50 . Recruitment process was appropriate and ensured that even the staff from abroad had their CRB disclosures both from their country of origin and from the UK. The manager stated that both POVA and CRB disclosures were returned in a short time. Staff files contained required documents: job application, proof of identity, references, training certificates and contracts. Several staff had sign language qualification and skill to communicate with potentially deaf service users. All new staff were inducted on “Skills for Care” principles and in accordance with legislative requirements and the home’s induction package. Ridgeway Lodge DS0000014952.V257302.R01.S.doc Version 5.0 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 35 Service users financial affairs were protected by appropriate and accurate records and the opportunity existed for service users to get their money whenever they wanted. EVIDENCE: The atmosphere in the home was open, constructive and inclusive. Staff knew their roles and responsibilities. Creativity was encouraged and a senior staff member responsible for monitoring medication was independently seeking the best solution for improving medication process that she would share with the rest of the staff on the next staff meeting. Service users and their families were encouraged to manage the service users’ money. Several users had small amount of cash that they liked. When the home kept users’ personal allowances, all transactions were recorded and traceable. Records showed accurately transactions and correct balances. A statement with the expenditure and current balance was available at any time for any individual. The balances checked for 3 service users were accurate and covered by receipts and records.
Ridgeway Lodge DS0000014952.V257302.R01.S.doc Version 5.0 Page 18 Ridgeway Lodge DS0000014952.V257302.R01.S.doc Version 5.0 Page 19 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 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 X 8 3 9 2 10 4 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 4 15 x COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 x X X X 3 X 3 X x STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X 3 X X 3 X X x Ridgeway Lodge DS0000014952.V257302.R01.S.doc Version 5.0 Page 20 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 OP9 Regulation 13 Requirement The risk assessment for leaving medication to service users to take without staff present must be drawn up. Timescale for action 15/11/05 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 Refer to Standard OP9 Good Practice Recommendations A person responsible for medication should identify the safest practice for administering liquidised medication and complete the negotiation to have medication delivered to the home in blister packs. Ridgeway Lodge DS0000014952.V257302.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Bedfordshire & Luton Area Office 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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