Inspection on 11/02/09 for Ridgeway Nursing Home

This inspection was carried out on 11th February 2009.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Ridgeway Nursing Home 14/03/07

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Ridgeway Nursing Home Crich Lane Ridgeway Belper Derbyshire DE56 2JH     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Susan Richards     Date: 1 1 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 34 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 34 Information about the care home Name of care home: Address: Ridgeway Nursing Home Crich Lane Ridgeway Belper Derbyshire DE56 2JH 01773853500 01773853957 paulabrowne1@hotmail.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Sudera Care Associates Limited Name of registered manager (if applicable) Ms Paula Browne Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 37 The registered person may provide the following categories of service only: Care Home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Dementia Code DE Old age, not falling within any other category - Code OP Date of last inspection Brief description of the care home Ridgeway Nursing Home provides nursing and personal care for up to 37 older persons and with dementia. The original large detached brick house has been extended to provide purpose built accommodation standing within it own ground in a pleasant rural setting. It is located close to a public transport route and within two miles of the market town of Belper. Care Homes for Older People Page 4 of 34 care home 37 Over 65 0 37 37 0 Brief description of the care home There are thirty-three single and two double/shared bedrooms (with one of the shared doubles being used as a single at the time of the inspection). All bedrooms rooms have wash hand basins, although no en suites are provided. There is a choice of bathroom and toilet facilities and lounge and dining rooms and a range of equipment and adaptations to assist those people who may have mobility problems, including a passenger lift to the first floor and an emergency call system throughout. People are provided with care and support from a team of nursing, care and hotel services staff and including a part time activities co-ordinator, led by the registered manager. Information about fees charged and what they cover can be obtained directly from the home and the range of fees charged per week is also specified within the summary section of this report. Care Homes for Older People Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is two stars. This means the people who use this service experience good quality outcomes. For the purposes of this inspection we have taken account of all the information we hold about this service. This includes our annual quality assurance assessment questionnaire (AQAA), which we ask the home to complete on an annual basis in order to provide us with key information about the service. We also received some survey returns from people who use the service, their relatives and staff employed there. We also received a number of comments from people who use/visit the service. Some of these are referred to below. Care Homes for Older People Page 6 of 34 The meals are good. Staff always come when I ring my call buzzer. They help me in the way that suits me. The manager is always approachable. Always on the ball and deals with any issues raised. We used case tracking as part of our methodology, where we looked more closely at the care and services that three people receive. We did this by talking with them, observation of staff interactions with them, looking at their written care plans and associated health and personal care records and by looking at their private and communal accommodation. We were assisted by an Expert by Experience. We somtimes engage the services of such an Expert to provide us with an independent view of the home. Our Expert spent time with people, looking at how their rights to independence, choice, respect and dignity are promoted within the context of their daily lives. And with particular focus activities, meals and staff approaches towards people. We spoke with staff about the arrangements for their recruitment, induction, training, deployment and supervision and we examined related records. We also spoke with the manager, who has managed the home for a number of years, about the arrangements for the management and administration of the home and we examined associated records. All of the above was undertaken with consideration to any diversity in need for people who live at the home. At the time of our visit all people accommodated are of British white backgrounds and of Christian religion. As at the date of this inspection, the range of fees charged per week is: 345.52 to 364.31 pounds per week for personal care only. The actual fee charged here is dependant on individuals assessed needs. 480 pounds per week standard rate for nursing care. There are also additional charges where an individual is accommodated in a double room for their only use as a single room facility. Rates for these start at 550 pounds per week, the full amount of which is dependant on individuals assessed needs. What the care home does well: What has improved since the last inspection? The Service Guide/Statement of Purpose for the home has been developed to better inform people about the home and the services it intends to provide, and is now available in a large print format. The requirements we made at our last key inspection of the service are complied with at this visit, relating to specified areas of record keeping and some environmental improvements. Work has commenced to develop an enclosed outdoor courtyard area to provide a sensory garden there and there are also some improvements to environmental security. Arrangements for staff training and support have continued to develop, including access and undertakings of care staff towards the achievement of care relevant NVQ training and with regard to clinical supervision arrangements. The results of the homes most recent satisfaction survey to residents and their relatives are published in the Service User Guide, providing existing and potential service users and their families with the views of people who use the service or who have an interest there. The registered manager has achieved a recognised management award. Care Homes for Older People Page 8 of 34 What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 34 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are overall suitably informed about the services home intends to provide and their needs are well accounted for. Evidence: At our last key inspection we found that people were reasonably well informed and supported during their admission process and their needs met, although we made some quality recommendations about the provision of key service information in alternative formats that may better assist some people. In our annual quality assurance questionnaire completed by the home, they told us they continue to provide people with a service information pack, which is now available in large print format and ensure their needs are suitably met prior to their admission. However, they also told us that they are seeking to introduce a revised more detailed Care Homes for Older People Page 11 of 34 Evidence: version of their service information. And they gave us some statistical information that we asked for about the people they accomodate at the home, which assisted us in the planning of our inspection. At this inspection, people told us they received most of the information they needed about the home to assist them or their relative in choosing to live there. And that they usually receive the care and support they need. Our expert by experience saw that a range of service information was provided in one persons room they visited. Although the information provided was dated October 2006. Information was also included, about how to access the most recent inspection report and the noticeboard, which was visibly located, provided people with names and photographs of staff who work at the home and other photographs of service users taking part in activities organised at the home. The manager provided us with a copy of the recently revised service guide, to be introduced. This gave people with most of the key service information, although the range of fees charged per week was not specified and people were not informed as to the arrangements for payment of any free nursing care element of the fee that may be apply. We saw that peoples recorded needs assessment information was comprehensive and person centred. A revised format was introduced to account for the homes recent change of registration category to include care and accommodation for people with dementia. This revised format is person centred and also includes focused consideration as to peoples individual capacities to make key decisions about their lives and to consent to their care and treatment. Care Homes for Older People Page 12 of 34 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples personal and health care needs are usually effectively accounted for. Evidence: At our last key inspection we found that peoples health needs were effectively promoted and met from staff that treated them with dignity and respect. We made two requirements relating to medicines administration record keeping and risks associated with the use of bedrails. We found that these are complied with at this inspection. In our annual quality assurance questionnaire completed by the home they told us about some of the things they continue to do and improvements they have made to ensure peoples health care needs are met. The latter refers to developments in their needs assessment and care planning formats to bring them in line with current practise concerned with the care of older people, including those with dementia. And some specified areas of staff training, delivered to assist them in effectively meeting peoples needs. Care Homes for Older People Page 13 of 34 Evidence: They also told us about further improvements they aim to make over the coming months, to be effected by way of staff training and they gave us some statistical information that we asked for. At this inspection people who use the service, or their relatives told us that they usually receive the care and support they need, including medical support. Our Expert by Experience spoke with some people, who gave positive feedback in respect of their personal and health care arrangements. These included for their access to outside health care professionals and for the purposes of routine health care screening. One person said that their own chiropodist and hairdresser visited them regularly and that staff supported them well in their preferred daily hygiene routines. Comments received told us that staff are caring, responsive and treat people with respect. Our Expert saw that staff responded in this manner with a resident who had fallen during our visit. Care plans that we looked at were, for the most part, person centred and formulated in accordance with peoples risk assessed needs and reflective of recognised guidance concerned with the care of older people and for the most part, including those with dementia. And they had regularly recorded reviews. We could also see developments in these that the provider told us about in our AQAA, including determining effective nutrition for people. The arrangements for the management and handling of peoples medicines were found to be overall satisfactory. Although the homes written policy and procedure confirmed by staff, in respect of any verbal instruction from a GP for the administration of a persons medicines, did not fully accord with recognised medicines practise standards. And we found that the supply of medicines by staff to one person who managed their own, also did not meet with recognised practise standards. We discussed these with the manager who agreed to take the necessary action to ensure that these were rectified. However, discussions with staff and the content of some care plans told us that benefit may be obtained from additional training for some staff. So as to further assist them in determining and/or delivering care interventions to people with dementia who may be resistive to care and/or have wandering behaviours. We have referred to this under the Staffing section of this report. Care Homes for Older People Page 14 of 34 Evidence: Care Homes for Older People Page 15 of 34 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples daily living arrangements, usually accord with their chosen routines and lifestyle preferences. And they are provided with nutritious food, which suits their needs and expectations. Evidence: At our last inspection of this service we found that people benefitted from the importance the home placed on promoting activities and community contacts and in ensuring they receive nutritious meals. We made a recommendation that information be provided for people about how to access advocacy services and found at this inspection that this is achieved. In our annual quality assurance questionnaire completed by the home they told us that their activities co-ordinator is suitably trained via a nationally recognised organisation concerned in the promotion of suitable activities for older people. They also gave us a range of information about activities they provide for people, working with volunteers, their inclusion of famlies and friends and access to local community groups and for religious worship. Care Homes for Older People Page 16 of 34 Evidence: Improvements they identified over the last twelve months, include purchasing a pet rabbit and starting to develop an enclosed courtyard area for people to access. And over the coming months they tell us they aim to provide a sensory garden in the courtyard area and to purchase a large screen TV to enable easier viewing for people. At this inspection people told us there are usually activities they can join if they choose. We saw a certificate displayed, which told us that the home is a member of NAPA (National Association for Provision of Activities) which promote therapeutic activities and training and networking opportunities for the activities organiser and concerned with older people. Our Expert saw that there was a range of equipment provided to assist in activities and she observed that people chose when to switch the TV on. Some people told her about their preferred daily living routines and arrangements for meals and mealtimes, which they said are flexible and usually accord with their preference and choices. People also advised her that a hairdresser visits the home regularly. We saw that there is an activities programme Monday to Friday, providing a range of activities that people can join. These include manicures, reminscence, sensory music, afternoon teas, skittles, board garmes, reading circle, talking books and a visiting library. Chair based exercises, letter reading, magazines and newspaper reading, singing, seasonal crafts and celebrations. There are regular visit to the home from representatives of local churches and with church services organised there. Entertainers regularly visit the home and one person comes in to read seasonal poetry to residents, which som particularly said they enjoy. The local dancing school put on an annual show and there are regular visits to the local community using Community Transport to local shops, places of interest and garden centres. There is also a monthly newsletter to residents and their relatives to keep people informed of current and forthcoming events. Our Expert found the activities co-ordinator to be very enthusiastic about her job and that the home provided a good collection of materials and equipment to assist in promoting activities. Many residents enjoy the fish tank, a small pet rabbit and two dogs regularly visit the home with their owners. One person told our Expert that she likes to walk in the gardens with staff support and people told us they like to watch the natural wildlife there, including the birds attracted by the bird feeders that are placed so that people Care Homes for Older People Page 17 of 34 Evidence: can view these from inside the home as well as outside. People who were able told us they usually enjoy the food at the home. One person told our expert that they choose to have their meals in their own room and with a glass of wine at lunchtime. Menus that we saw provided a nutritious and balanced diet with a full breakfast choice, main set meal at lunchtime and a lighter tea offering a hot and warm alternative. Mid morning and mid afternoon snacks and drinks are also routinely offered, together with supper drinks and a snack box is left out for people to access when they choose. There is also a large cold water dispenser with cups that people can use. Although lunch is a set meal, we saw that the chef consults with people on a regular basis in order to determine menus. And also on a daily basis, where an alternative the the main meal can be ascertained for anyone who does not wish to have this. We observed at lunchtime two people sitting in one of the dining rooms, who had an alternative to the main meal offered. We also saw that people chose where to take their meals and that people who needed, were appropriately assisted and supported by staff in accordance with their individual needs. Care Homes for Older People Page 18 of 34 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People may be assured that any complaints or concerns they raise will be taken seriously and acted on by the home, and that they will be protected from harm and abuse. Evidence: At our last key inspection we judged that people could be confident to raise concerns or complaints and that they were protected from abuse. In our annual quality assurance questionnaire completed by the home, they told us they operate an open door policy to encourage good communication with people who use the service or with people who have an interest there. And, that they promote a message of zero tolerance of abuse and ensure prompt responses and action to any complaints they receive. At this inspection, we saw that the complaints procedure is openly displayed and that information about how to complain is also provided within the homes service user guide. People told our expert that they were confident in raising complaints with staff and the manager. Comments made include, I would tell the manager, who would definitely do something about it. She is always on the ball. Care Homes for Older People Page 19 of 34 Evidence: The manager is always quick to respond, I have no concerns about my mothers safety. Staff spoken with were conversant with their roles and responsibilities concerned with handling complaints, recognising abuse and procedures to follow in any such event of. Examination of staff files and training records showed us that staff receive regular training and updates in this area. Information that we hold about the service and examination of the homes complaints records tells us that there has been three complaints about the home since our last key inspection there. Two of these were investigated via joint agency safeguarding vulnerable adults procedures and one internally by the home manager. Of the two investigated via joint agency procedures, one was partially upheld and the other is awaiting an outcome. The complaint received by the home was upheld. We could see from discussions with people and from the homes records that the home has taken the necessary action in respect of these to ensure peoples health and welfare is protected. Care Homes for Older People Page 20 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Overall the home is clean, comfortable and odour free and reasonably well maintained. Although some environmental risks identified, are not best accounted for and the environment does not maximise the independence of people with dementia. Evidence: At our last key inspection we found the home to be clean and comfortable and for then most part, reasonably well maintained, suiting peoples overall needs. However, that the state of some floor coverings and commodes undermined overall environmental quality and potentially undermined the promotion of good infection control. We made some requirements relating to these, which we found to be met at this inspection. In our annual quality assurance questionnaire, the home told us that they provide a safe, comfortable, clean and homely environment, which is odour free. That people have a choice of communal space, with safe access to outdoor garden and courtyard areas. They told us about some of the improvements they have made, to further assist in promoting peoples choice and satisfaction within their environment and their security Care Homes for Older People Page 21 of 34 Evidence: and safety. And said they could do better in terms of decor and furnishings modernisation and by providing some en suite accommodation. However, improvements they have told us they aim to make, focus on the ongoing carpet renewal to bedrooms and in developing their sensory and herb garden in the courtyard area. At this inspection we saw that a homely, clean and comfortable environment is provided for people, which overall was well maintained, safe and odour free. And that bedrooms were personalised and for the most part, suited peoples needs. Although, people were not able to access one of the bathrooms due to the bath requiring repair. We were advised that arrangements were in hand to address this. We saw where carpets had been replaced with new since our last inspection and the manager advised of others that were to be replaced. However, we saw that some beds and mattresses were old and worn and discussions with the manager told us that there is no method for testing mattress viability or to link into a programme of renewal. We also saw a notice in one of the bathrooms on the ground floor stating that all showers and some baths have suitable control valves fitted to the hot water outlet for the purposes of safely regulating the temperature of hot water emitted from these. But that some bathing outlets do not. These notices also reminded staff as to the procedure to follow when running a bath for any service user to assist in reducing risks of scalding. We advised the manager at our visit that all bathing hot water outlets must have suitable control devices fitted to prevent risks to people from scalding. Since our last inspection the manager had engaged the Infection Control nurse from the local primary care trust to undertake an audit of the premises and had fully implemented the action plan arising from that audit. The laundry room was kept locked and was clean and in the main suitably equipped, although there was no rollator iron provided to assist with larger items, such as sheets and bedlinen. Suitable hand washing facilities and equipment is also provided for staff and in communal bathrooms and toilets. Our Expert saw that pictures of items from the past were hung in corridor and lounge areas for people to identify with. And that picture signs were provided on bathroom and toilet doors to assist people in their orientiation. However, observations and discussions with people told us that a full assessment of the premises and facilities had not been undertaken, to determine the need for further Care Homes for Older People Page 22 of 34 Evidence: environmental adaptations that may be necessary to meet the needs of people with dementia and to best assist them in their orientation. Our Expert also saw that when carers served tea during the afternoon, that there was no staff member in the large lounge for a well over ten minutes and that some residents were not able to open the door as they tried, which had a key pad type lock. The manager advised the Inspector that people should not be left unsupervised here. The Inspector discussed the potential risks to people from the electric fire with free standing fire guard in the large lounge. The manager advised that there was a recorded risk assessment in place in respect of this. Care Homes for Older People Page 23 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People may be assured that their needs will be met from staff that is effectively recruited, inducted, trained and deployed. Although the completion of specified staff training should further increase staffs capacity and confidence in supporting people with dementia. Thereby, further promoting peoples best interests. Evidence: At our last key inspection here we found systems and arrangements for the recruitment, induction, training and deployment of staff in the home to be satisfactory. We made one recommendation that at least fifty percent of staff achieve at least NVQ level 2 or above. We found at this inspection that this is almost achieved, with five out of sixteen having achieved this and a further seven staff in process of undertaking these. In our annual quality assurance questionnaire completed by the home, they told us they ensure a good staff retention rate, with staff from diverse backgrounds providing a wide skill mix. And that they promote a climate of respect and tolerance from staff that is committed to their continual training and development so as to promote high standards of care. They told us about improvements they have made since our last inspection, which Care Homes for Older People Page 24 of 34 Evidence: includes a variety of specified staff training, including in respect of dementia awareness, safeguarding vulnerable adults and the Mental Capacity Act 2005. Along with training in respect of specified medical conditions of service users and areas of clinical update and training for the registered nurses they employ. They also told us about improvements they aim to make concerned with manpower planning arrangements and in ensuring ongoing staff training. At this inspection people told our expert by experience that there are always plenty of staff that always respond when needed. One person said, staff are really caring and are quick to respond. When I press my call buzzer staff always come to me. Our expert observed staff to demonstrate a caring attitude to residents and to treat them with respect. Staff described satisfactory arrangements for their recruitment, induction, training and deployment. And associated records that we looked at reflected these. Some staff said they had requested the manager to proivide further more indepth training relating to dementia care and specifically in respect of dealing with challenging behaviours and control and restraint. We asked the manager about the progress made in providing this training, given their agreement with us to do so within two months of our registration approval in June 2008 enabling them to accommodate people under the category of dementia, DE. The manager advised that some but not all staff had undertaken this and with further planned. However she was not able to locate the training plan, which was said to be with the regional manager and we did not see any certificates or evidence of that specific training provision. The manager agreed to provide us with a copy of the training plan. Care Homes for Older People Page 25 of 34 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Overall, the home is well managed and run in peoples best interests, with their health, safety and welfare usually promoted and protected. Evidence: At our last key inspection here we found the home to be well managed, with peoples best interests, health, safety and welfare suitably promoted and protected. We made a recommendation. That the registered persons publish the results of any satisfaction surveys. We found at this inspection that this is achieved with a summary of the results of the most recent survey detailed in the revised Service User Guide. These included that from surveys that were completed and returned, one hundred percent of people felt the home meet their needs. One hundred percent were happy with the quality of food provided. Eighty percent said they receive the assistance they need. Ninety percent said they do not want to go on organised group outings and one hundred percent said that their visitors are always made welcome. Results also detail Care Homes for Older People Page 26 of 34 Evidence: where areas for improvement are identified, together with action taken by the home to address these. In our annual quality assurance questionnaire the home completed, they told us they operate and open door appraoch to management. With an ethos of openness, transparency and accountability, where personal development is promoted and with no blame culture. They told us about some improvements they have made since our last inspection. These include staff clinical supervision arrangements and practise and that the manager has achieved the Registered Managers Award, along with other areas of specified training and with a focus on dementia care. They also told us that the home has qualified as a quality premium service with Derbyshire County Council, their local funding authority for service user placements there. However, we found that reports of monthly visits to the home that are required from the provider or their representative so as to form an opinion as to the quality of nursing care and services that people receive there, were not provided in the home for the manager or for our inspection. Aims for further improvement focus on management networking systems. They gave us some statistical information that we asked for about the servicing and maintenance of systems and equipment at the home, arrangements for infection control promotion and service user admissions over the last twelve months. And we saw at this inspection from speaking with people at looking at associated records that these are mostly satisfactory. However, information that we received from some service users or their representatives, indicated that there may be problems with the hot water supply to sinks in some peoples rooms. Discussions with the manager and examination of a recent servicing records and a quote for works required, showed this to be the case. Although there was no date specified for these works to be undertaken. At our visit we looked at the arrangements for quality assurance and monitoring in the home. We found that reports of the required monthly visits to the home from the registered provider so as to ascertain an opinion of the quality of nursing care and the conduct of the home were not provided. And with no service audits recorded since November 2007, with the exception of that relating to infection control. Care Homes for Older People Page 27 of 34 Evidence: We looked at the arrangements for the management and handling of peoples personal monies via case tracking and found these to be satisfactory, atlhough records of income and expenditure on individual service users balance sheets had only one signature, of the staff responsible. We recommended that for good practise, where possible there should be two signatures, the second being either the service user or their representative or a witnessing staff member. Staff described overall satisfactory arrangements for ensuring safe working practises at the home, including the provision of necessary equipment and related records that we examined were reflective of these. And, with the exception of matters detailed under the Environment section of this report, regarding hot water emissions from some bathing outlets, we saw that the home was free from observable hazards to peoples safety. At this inspection all people spoke very highly of the registered manager and staff described suitable arrangements for communication in the home and for their supervision and support. We saw a number of positive comments made in survey returns and plaudits relating to the management of the home, including, I have always found staff to be patient, good humoured and extremely caring. I would have not hesitation in recommending Ridgeway under Paulas management to anyone. Care Homes for Older People Page 28 of 34 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 29 of 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 1 5A The range of weekly fees charged by the home must be specified within the service guide and information provided there as to the arrangements for payment of any free nursing care element of the fee that may apply. So as to fully inform people about fees charged and what they cover, to assist them in choosing to live at the home. Service users medicines must not be removed from their original labelled containers dispensed by the pharmacy supplier for the purposes of their storage. Whether this is for storage by the home on behalf of any service user or to give to any service user deemed competent to manage and store their own medicines. 31/05/2009 2 9 13 31/03/2009 Care Homes for Older People Page 30 of 34 So as to ensure that secondary dispensing does not take place and to provide for the correct and safe storage of peoples medicines at the home. 3 25 13 Pre-set valves of a type unaffected by changes in water pressure and which have fail safe devices must be fitted locally to bathing outlets to provide hot water close to forty three degrees centigrade. So as to prevent risks to service users from scalding and to ensure that unnecessary risks to service users are eliminated. 4 30 18 All staff must receive training in dealing with challenging behaviours and the use of control and restraint. So as to ensure that staff are trained, competent and confident to do their jobs. 5 33 26 Reports of monthly visits to the home from the registered provider must be made available to the registered manager and to the Commission. So as to ensure that visits are conducted in accordance with this regulation. And to ensure ongoing monitoring as to the conduct of the 30/04/2009 31/05/2009 30/04/2009 Care Homes for Older People Page 31 of 34 home by the registered provider. 6 38 23 Necessary maintenance and repairs to the hot and cold water system must be undertaken. So as to ensure hot and cold water systems are kept in a good state of repair and that an effective water supply is distributed to people rooms and their washing/bathing outlets. 31/05/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 9 A quality assessment and monitoring tool should be developed to measure the homes success in complying with its medicines policy guidance and with recognised guidance concerned with the management and administration of medicines at the home, including where people retain and administer their own medicines. Medicines policy guidance for staff, regarding procedures to follow in the event of any verbal instruction from a GP for medicines to be administered to a service user, should be reviewed. So as to ensure they meet with recognised practise standards concerned with this, with regard to the role and responsibilities of the staff member and second witnessing staff member responsible for the recording of these. A rollator iron should be provided to assist in the ironing of larger items, such as bedlinen. A programme for the viablity testing of mattresses and beds should be introduced and linked to a formal programme of routine maintenance and renewal. Where any service user is subject to physical restraint of the kind employed by the use of key pad locks to doors, that staff supervision should be ensured at all times so as to enable people to wander freely and safely. 2 9 3 4 19 19 5 19 Care Homes for Older People Page 32 of 34 6 19 The fire guard to the electric fire in the main lounge should be fixed when the fire is on, so as to prevent its movement and to avoid unnecessary accidents to service users. The environment should be developed to provide considered equipment and environmental adaptations to meet the needs of people with dementia and to maximise their independence. Where possible, an assessment of the premises and facilities should be undertaken by a suitably qualified person with specialist knowledge of the client group accommodated. So as to inform and assist the home in achieving this. A copy of the staff training plan should be forwarded to the Commission. The homes quality assurance and monitoring systems should be operated in a continuous cycle, with records of key systems and service audits that are kept up to date, along with any necessary action or development plans, that are regularly reviewed. So that the service effectively measures its own success in achieving its aims and objectives. Records of income and expenditure kept in respect of individual service users personal monies that are stored on their behalf by the home should, where possible record two signatures witnessing these. So as to underpin safe practise. 7 22 8 9 29 33 10 35 Care Homes for Older People Page 33 of 34 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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