Inspection on 01/09/05 for Ridgewood

This inspection was carried out on 1st September 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Ridgewood 01/05/07

Ridgewood 22/02/06

Ridgewood 23/02/05

Ridgewood 10/08/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Ridgewood 54 Mount Pleasant Road Camborne TR14 7RJ Lead Inspector Richard Coates Announced 01 September 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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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. Ridgewood D52-D04 S34044 Ridgewood V237249 010905 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Ridgewood Address 54 Mount Pleasant Road Camborne TR14 7RJ 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) 01209 710799 01209 714624 alison@mjbridgewood.co.uk Matley-Jones Brown Ltd Alison Jean Brown Care Home 10 Category(ies) of Learning Disability (10) registration, with number of places Ridgewood D52-D04 S34044 Ridgewood V237249 010905 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: No conditions have been set. Date of last inspection 23 February 2005 Brief Description of the Service: Ridgewood is a detached house situated in a residential area of Camborne. The Registered Provider is Matley-Jones Brown Ltd. Mr P Brown is the Responsible Individual and Mrs A Brown is the Registered Manager. Ridgewood is registered to provide accommodation and care for up to ten adults with a learning disability. The aim of the registered provider is to accommodate service users with more complex needs. The statement of purpose states that the age group intended is between 30 and 65 on admission. The home provides ten single bedrooms. These are situated on both the ground and first floor. Accommodation on the first floor is for physically able service users. All bedrooms have their own toilet and hand basin; some have their own bath. There is a range of spacious communal rooms on both floors. The front door provides access to wheelchair users and the ground floor is on one level. There is a spacious and secluded garden. The home is within walking distance of the town centre and local facilities. The Social Services Department commissions day activities for some service users, and the provider arranges day activities for other service users as part of their package of care. Ridgewood D52-D04 S34044 Ridgewood V237249 010905 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a planned announced inspection carried out on Thursday 1 September 2005. The aim was to focus on key standards in the areas of care planning, personal and healthcare support, staffing and the management of the home. The remainder of the key standards will be included in the unannounced inspection later in the year. There were no requirements or recommendations from the last inspection report, dated 23 February 2005, to follow up. The inspector spent time with management, staff and residents, examined records and documents, and toured the premises. The inspector wishes to thank the deputy manager, staff and residents for their assistance in completing the inspection. What the service does well: The service draws up care plans based upon assessment evidence and the views of residents and their representatives. The care plans inform, direct and guide care staff in meeting the needs of residents. Staff also record thorough risk assessments for each resident in areas of activity and risk. These assessments provide clear instructions to staff on how to manage risk while supporting residents in activities. The residents are assisted to be as independent as possible in relation to their care needs, to make decisions about their lives and to enjoy their preferred lifestyle. Positive use is made of suitable communication formats for residents with reduced communication abilities. The provider uses recording formats suited to meeting the residents’ individual care needs- for example records of behaviour. The changing and sometimes complex healthcare needs of residents are well monitored and addressed. The records for residents of healthcare referrals, appointments and contacts with healthcare professionals are very thorough. The provider takes a proactive approach in ensuring the access of residents to healthcare services. Service users said that they were satisfied with the care and support that they receive. The home has a good balance of staff in respect of age, gender and experience. Staffing levels are above the minimum required and this facilitates one to one and small group activities. The provider has a structured training programme which covers induction, regular training in health and safety and other required areas, and the NVQ in care. The deputy manager has completed the registered manager award. Staff made positive comments about the training arrangements and the quality of the supervision and support that they receive. The number of staff with an NVQ at level 2 or 3 exceeds the 50 level set by the standards for the end of 2005. The provider has robust systems in place to comply with health and safety legislation and to address any issues that arise. The premises and equipment are well maintained. Ridgewood D52-D04 S34044 Ridgewood V237249 010905 Stage 4.doc Version 1.40 Page 6 What has improved since the last inspection? 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. Ridgewood D52-D04 S34044 Ridgewood V237249 010905 Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Ridgewood D52-D04 S34044 Ridgewood V237249 010905 Stage 4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) see below No new residents have been admitted since the last inspection. Previous inspections have shown that the provider’s policy, procedure and practice in respect of these standards have complied with the regulations and standards. EVIDENCE: Ridgewood D52-D04 S34044 Ridgewood V237249 010905 Stage 4.doc Version 1.40 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7 and 9 Care plans reflect the residents’ needs and personal goals and the risk assessments support residents to take risks so that they can pursue an independent lifestyle. EVIDENCE: Two service users records were case tracked. Each had a detailed care plans based on a ‘strengths and needs’ assessment. Care plans are signed and dated and cover the assessed needs in specific areas of activity and risk. The plans detail for staff the need, the intervention required and the desired outcome. Plans include supplementary information particular to each individual and specific records suited to the care needs of each individual. Reviews were documented and had planned dates for the future. There were detailed risk assessments. Where appropriate, these documented agreed restrictions on choices and freedom. Relatives stated that they were consulted in the care planning process in comment cards submitted to the inspector. The deputy manager reported that care plans were discussed with residents. Each resident has an identified key worker. Staff complete daily records of activities and events which are signed and dated. The provider should ensure that the daily records link appropriately with the individual goals in each resident’s care plan. Ridgewood D52-D04 S34044 Ridgewood V237249 010905 Stage 4.doc Version 1.40 Page 10 One care plan appeared to require a review before the set date, and this was about to be carried out. The care plans set out the residents’ lifestyle preferences. The deputy manager discussed a number of examples where support was provided in decisionmaking. Daily records and observation provided examples of staff supporting service users to make decisions in day-to-day matters – for example activities, food and drink, and outings. Positive use is made of a pictorial communication system with one resident. Service users informed the inspector that staff supported them in making decisions. A number of residents attend, somewhat irregularly, a self-advocacy group at Pool. The registered provider and deputy manager are aware of the Cornwall Advocacy Service, which is now operational. The registered manager is appointee for benefits for three service users. There are varied arrangements for managing the finances of the other service users – two by financial representatives, others by relatives and the Social Services Department. These were set out in the pre-inspection questionnaire. The records case tracked contained detailed risk assessments for activities and areas of risk. The assessments directed staff in specific interventions to control risk. Risks are assessed before admission as part of the assessment and admission process. The deputy manager discussed examples where residents were supported to take responsible risks. There is a missing service user procedure. Ridgewood D52-D04 S34044 Ridgewood V237249 010905 Stage 4.doc Version 1.40 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) These standards will be inspected in the unannounced inspection later in the year. EVIDENCE: Ridgewood D52-D04 S34044 Ridgewood V237249 010905 Stage 4.doc Version 1.40 Page 12 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19 and 20 The arrangements for providing personal support to residents and for meeting their healthcare needs are satisfactory. The policies and procedures for dealing with medicines generally protect residents, but some attention is required to medicine administration records. EVIDENCE: There is a policy and procedure on the provision of personal care. Personal support is always provided in private. The deputy manager discussed the care of one resident who requires intensive assistance with personal care and the use of equipment. Advice and guidance have been obtained from the appropriate clinical specialist and the community nurses. All service users have their own toilet, and curtains have been installed for those who may not close the door. Service users have designated key workers. Care plans direct and inform staff about the interventions required to meet the residents’ personal care needs, and identify the strengths of residents and how they can be supported to be independent. There is a mix of male and female care staff proportionate to the four male and six female residents. Residents provided positive feedback to the inspector about the care provided. Residents choose their own clothes with some guidance as to weather conditions and proposed activities. Relatives stated that they were satisfied with the overall care provided in comment cards returned to the inspector. Ridgewood D52-D04 S34044 Ridgewood V237249 010905 Stage 4.doc Version 1.40 Page 13 The records provided evidence that the registered person ensures that the residents’ healthcare needs are assessed, recognised and addressed. All residents are registered with a GP. Contact records detail appointments and treatment with GPs, community nurses, clinical specialists, consultant psychiatrists, chiropodists, dentists, opticians and other healthcare service. Daily records and correspondence document the monitoring and addressing of residents’ healthcare needs and the involvement of specialist workers. Care planning and documentation in respect of the healthcare needs of individual service users is well developed and detailed. The deputy manager discussed how the changing and complex healthcare needs of three residents are being met and the involvement of multi-disciplinary healthcare teams in this care. There is a policy and procedure on the handling of medicines and the registered person has a copy of the Royal Pharmaceutical Society guidance. Medicines are stored in a locked cupboard in the dining room/sitting room. A member of staff went through the systems for managing medicines. There were no controlled drugs reported as in use at the time of the inspection. The Boots monitored dosage system is used. The administration records document the checking on receipt, the administration and the disposal of medicines. The medication administration records folder contains photographs of residents. Patient information leaflets are retained in individual files. The medication administration records were well maintained in the main. There were a small number of gaps in signatures for administration; counting the tablets in these cases suggested that the drug had been administered. Staff do not use consistently the suggested codes for reasons for non- administration of medicines. Changes to the prescription for individual service users are dated and referenced. A random check of medicines against the medication administration record showed correct dosage and stock. No medicines past their expiry were found. No medicines requiring storage in the refrigerator were in use. The provider may have to review in the future the need for a separate refrigerator for medicines if more medicines requiring refrigeration are held. The pharmacist had visited on the 31 January 2005. Staff who administer medicines have completed a course in the safe handling of medicines. Ridgewood D52-D04 S34044 Ridgewood V237249 010905 Stage 4.doc Version 1.40 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 The systems for listening to the views of residents and their representatives are satisfactory. EVIDENCE: There is a complaints procedure which complies with the standard and the regulation. The procedure is included in the statement of purpose. The preinspection questionnaire recorded that there have been no formal complaints since the last inspection. A complaints and comments book is available in the entrance hall. Ridgewood D52-D04 S34044 Ridgewood V237249 010905 Stage 4.doc Version 1.40 Page 15 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) See below These standards will be included in the unannounced inspection later in the year. EVIDENCE: The sitting room/activity room on the first floor is in the process of being decorated. Ridgewood D52-D04 S34044 Ridgewood V237249 010905 Stage 4.doc Version 1.40 Page 16 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 34 and 35 The staff team is effective in supporting residents. The arrangements for training and personal development of staff are satisfactory and ensure that the individual and joint needs of residents are met. Recruitment practice protects the well being of residents. EVIDENCE: The Residential Forum model for calculating staffing levels applies to Ridgewood, as a home that has been first registered since April 2002. Application of the model sets a staffing level of just above 10 full time equivalent waking staff. The current staffing level is currently around 12 full time equivalent waking care staff. The staff roster details all staff on duty, including the registered manager and deputy manager, and on-call arrangements. This information is set out daily on a pictorial board in the ground floor hallway. There are three or four staff on duty during the daytime, with two waking staff at night. The ancillary staff comprises a housekeeper, a gardener/general assistant, and the responsible individual will be working as a cook five days a week from the 19 September. There are currently no trainee staff under 18. The deputy manager reported that vacancy levels are under review. Ridgewood D52-D04 S34044 Ridgewood V237249 010905 Stage 4.doc Version 1.40 Page 17 The deputy manager discussed the process of recruitment and selection of staff. Applicants are invited to the home for an interview, a look around and to meet residents. The views of residents are sought after they have met the applicant. The inspector examined two records of recent staff recruitment in detail and briefly examined two other records. The records contained structured application forms and interview records with standard questions and notes taken. The provider had obtained two references, Criminal Records Bureau disclosures, identity information, and copies of qualification certificates. The provider issues statements of terms and conditions to staff. The registered manager maintains a summary training matrix record for all staff detailing courses attended with dates. Each staff member has a more detailed individual training record. Induction is carried out using a checklist, staff handbook and health and safety guidance. The induction training is based on the specification set out by ‘Skills for Care’. A member of staff stated that her recent induction had been led by the deputy manager and signed off on a structured format. It had been comprehensive and useful, involving supervised work with residents. She had completed basic health and safety training and had been registered for her NVQ level 2. There is a rolling programme of regular training in moving and handling, health and safety, first aid, food hygiene, adult protection and fire safety. Some staff have attended the adult protection ‘alerters’ training and all staff should attend this when sufficient courses are available. Newly appointed staff who have an NVQ at level 2 have a formal appraisal which checks their work performance against the skills and knowledge required at NVQ level 2. Of the present staff, three have NVQ at level three (or equivalent), five have NVQ at level 2, and four are currently registered and working on their level 2. The provider has introduced a sixmonthly appraisal system. Records of appraisals were inspected. Ridgewood D52-D04 S34044 Ridgewood V237249 010905 Stage 4.doc Version 1.40 Page 18 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) EVIDENCE: The registered manager has completed the registered managers award, the NEBS level 4 in management and NVQ level 4 in care, and she is a registered nurse. She has the NVQ assessors award. The deputy manager has completed the registered managers award and an NVQ level 4 in care and holds an NVQ3 in promoting independence. The registered manager and deputy manager have recently attended training in infection control. Both posts have job descriptions which detail their respective responsibilities. There is a quality management policy and procedure. Ridgewood D52-D04 S34044 Ridgewood V237249 010905 Stage 4.doc Version 1.40 Page 19 A quality survey has been carried out this year through questionnaires to relatives and representatives and a summary of the outcomes has been included in the service users guide. The provider is intending to repeat this exercise next year. Staff have monthly 1:1 meetings with each resident which are recorded. Guidance on access to records requires that these records should be held individually. Where residents have communication difficulties, the methods used to obtain their views should be recorded. Staff use an ‘activity evaluation record’ to record the outcomes of activities with service users where care plans are being reviewed and developed. The registered manager and deputy manager obtain information on current good practice and initiatives in care. Residents were aware that the inspection was to take place and were supported to talk with the inspector. There is a policy on accident reporting and the inspector examined the accident records. Records were satisfactorily completed. The record complies with the Data Protection Act. The responsible individual has lead responsibility for health and safety. The provider issues a statement of health and safety policy to all staff. This sets out the corporate and individual responsibilities. All new staff attend a course in safety compliance. The responsible individual or a delegated member of staff carries out a monthly premises and health and safety audit. The registered manager has drawn up a fire safety risk assessment. The last visit by a fire officer was on 7 July 2005 and the letter to the registered provider stated that the arrangements were satisfactory. The inspector examined required records of checks on the alarm system, emergency lighting, and extinguishers. All fire exits have a list of service users and a floor plan posted. There is a policy and procedure on Legionella and control measures in place. Detailed COSHH information is held on all hazardous substances. The inspector checked against the original documents a sample of the comprehensive list of maintenance and safety records provided on the preinspection questionnaire. These were accurate. Ridgewood D52-D04 S34044 Ridgewood V237249 010905 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 Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x x x x x Standard No 22 23 ENVIRONMENT Score 3 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 x 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score x x x x x x x Standard No 11 12 13 14 15 16 17 x x x x x x x Standard No 31 32 33 34 35 36 Score x x 3 3 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Ridgewood Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score 3 x 3 x x 3 x D52-D04 S34044 Ridgewood V237249 010905 Stage 4.doc Version 1.40 Page 21 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 Regulation Requirement Timescale for action 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 20 Good Practice Recommendations Staff should use appropriate codes on records for the reason for the non-administration of medication. 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